


&-.*-< 



*9t 













UNITED STATES OF AMERICA. 



ERRATA. 

Page. 

9, Line 5, for " assertions," read assertion. 
11, Last line, after "emenate," read from. 
15, Line 7, for "natura," read naturae. 
18, Line 4, for " end," read ends. 
22, Line 8, for " loose," read lose. 
22, Last line, for " is" read he. 
25, Line 19, for " hydatics," read hydatids. 
29, Line 21, for " phenomena," read phenomenon. 

33, Line 5, for " have," read has. 

34, Line 23, for " is," read are. 

36, Line 2, for " medical," read medicinal. 
36, Line 13 and 20, for " raising," read rising. 
48, Line 13, for " is," read are. 
70, Line 4, for " was," read were. 
84, Line last, for " dilitation," read dilatation. 
104, Line 15, for " to," read in. 



CONSUMPTION 



CURABLE, 



PRACTICAL TREATISE 

TO PROVE 

CONSUMPTION 

A MANAGEABIE DISEASE : 

WITH CASES SUCCESSFULLY TREATED, UNDER A NEW MODE IN THIS 

COUNTRY. 



BY 



,^ * 



J. ST RO>E, M. D 




"Nature as well as art, operates to this end." 



PHILADELPHIA: 

CROLIUS & GLADDING, 

No. 341 Market Street above Ninth. 

J. G. AUNER, 

No. 343 Market Street, above Ninth. 

MDCCCXLI. 



Entered according to the Act of Congress, in the year 1841, by 
J. S. ROSE, M. D., 
in the Clerk's Office of the District Court in the Eastern District 
of Pennsylvania. 






PHILADELPHIA : 
KING AND BAIRD, PRINTERS, 

No. 9, George Street. 



PREFACE. 

What I now offer is an unprejudiced theory, 
confirmed by happy success in practice. And this 
I think must ever be the most effectual method to 
arrive at truth. 

I am sensible of the force of prejudice, and also 
the many difficulties attending an attempt to 
eradicate long established errors, though supported 
by men of fame. Yet I have ventured on the 
task, and in obedience to duty and truth, have 
pointed out many absurdities in practice, which 
must appear evident to every candid and unpre- 
judiced reader. 

But it must be remembered by all, that in 
pointing out the result of errors we do little, — if 
we fail to amend them. This has been my chief 
object ; and if writing what I must consider strictly 
true, be not a breach of modesty, I am decidedly 



PREFACE. 

of opinion, that this treatise will contribute more 
to the welfare of my fellow creatures, than any 
book I have seen or heard of on the subject of 
consumption. 

Where, I may ask, would surgery have looked 
for its improvements, had not the gigantic minds 
of Hunter, Bell, Home, Abernethy, Physic, 
Dorsey, Lawrence, and Parrish, with a host of 
others, among the departed, rendered clear the 
supposed mysteries of nature's- operation in the 
cure of disease, and by a well-timed application of 
art, shortened and speedily removed the cause of 
suffering ? 

The discoveries of these great men are too well 
known to need repetition here. 

Happily there are those among us still who 
possess the same zeal for research. Soon after 
the great operations of M. Heurteloup, Leroy, and 
Civiale, for the destruction of calculus in the 
urinary bladder, we found many of our American 
surgeons performing the same operation. The 
success of Randolph, McClellan, Gibson and others, 
is well known. 



PREFACE. 5 

The division of tendons for the cure of deform- 
ity, was looked upon — but a few years ago — 
as an operation impossible ; but after Delpech had 
cut the tendo-achillis, and cured club foot, the 
division of tendons was soon considered not only 
safe, but indispensable for the cure of deformity. 
Dr. Mutter, of our City, is now almost daily 
performing this operation with perfect success. 
Dr. Togno, however, deserves, in my opinion, the 
credit of introducing this operation to Phila- 
delphians. 

The daily papers of 1836 or 7 contained a hoax, 
that was then considered as ridiculous as the great 
moon story of New York. They asserted that 
a Physician would spend the summer near the 
springs at Saratoga, who could cure squinting. 
In conversation with a medical man in our city, 
with whom this matter was discussed, he ex- 
claimed : This cannot be, " Till Birnam wood 
remove to Dunsinane." 

To continue the language of Shakspeare, we 

may add, " And now the wood doth move/' for 

this operation has been performed on more than 

1# 



6 PREFACE. 

four hundred persons by Dr. Grossman, with 
perfect success, — not requiring for each case more 
than from five to twenty seconds. 

After all these facts, staring us full in the face, 
I cannot imagine it will be found difficult to 
believe, what has heretofore been considered 
doubtful, the curable nature of consumption. 



INTRODUCTION. 

It may appear somewhat curious to many of 
my readers, when they find that in my first 
attempt at authorship, 1 have selected a subject 
that will doubtless be received by many as 
fiction. The constant assertions of most, if not 
all of the distinguished members in the medical 
profession, as well as some of the most learned out 
of it, has been " Consumption cannot be cured." 
What ! cure Consumption ! take down the very 
peg upon which the medical profession have 
always hung their apology for failure, in the cure 
of disease? Yes, even so! The lawyer twists 
and turns in every way, when he is cast in a case 
at the bar, to form some excuse to his client, and 
finds a variety : such as, you did not tell me that 
or this fact before ; or, you should have had the 
other witness here, — or, the judge was partial — or, 
perhaps he knew no better; and we must try to 
have him removed from the bench, &c. &c., thus 



8 INTRODUCTION. 

satisfying the client. But the physician declares, 
that tubercles existed in the lungs, or abscess, or 
bronchitis, or adhesions, or enlargement of some 
important bloodvessel, or great disease of the 
heart, or its enlargement, were sufficient to cause 
death. I admit they are — but I shall show and 
clearly prove to the unprejudiced reader, that 
these diseases — although sufficient to cause death, 
if erroneously treated, or left to themselves, or 
sent to other regions, North, or even South, — can 
be cured as easily as fever, inflammation, rheuma- 
tism, dropsy, or any other of the vocabulary. 

Members of the medical profession, — myself 
among the number, — have too often been content 
to follow the dictates of others, without the least 
effort to mend their practice, or substitute a 
better. 

The cure of disease or the restoration of a 
patient to health, does not always depend on this, 
that, or the other nostrum, the swallowing of large 
or small mixtures, or plastering the surface with 
blisters, poultices, or suchlike things, or increasing 
the violence of remedies in the sinking stages, 
until the last lingering ray of hope is extinct. In 
this state of things, the physician of judgment rests 
on his oars, with his anxiety excited to its highest 



INTRODUCTION. 9 

pitch, watching the operations of nature, and 
viewing his patient and disease — as two animals 
exhausted by combat. The one or the other must 
now yield. That tranquil face, that composed 
countenance, inspires a hope ; let no rude gossip, 
now disturb the quiet of the becl-side, and all will 
be well. 

That smile which plays there great assurance gives, 
He sleeps — disease is prostrate, and he lives. 

But in this state of emergency, the friends 
will be soliciting consultation ; yield to it by 
all means — and if you are satisfied, from what 
you have seen, that the case must terminate 
favourably, make this statement to your medical 
friend, and he will assist you in holding fast on 
that confidence the family repose in you, which is 
so very requisite for your success in the treatment 
of all their diseases. In large cities, we possess 
advantages that are never enjoyed by our medical 
brethren in country practice. Here we cannot go 
amiss, — the talent, experience, high-minded, and 
honorable character of the medical profession, 
invite consultation. But should consultation be 
requested by partial strangers, and not be proposed 
by the patient, or some deeply interested friend, or 



10 INTRODUCTION. 

member of the family, resist it, or decline attend- 
ance, unless you are decidedly at a loss how to 
proceed in the case. 

In consultation you may gain golden opinions, 
you may find many, who possess by genius, what 
others have obtained by hard and constant study. 
Cnvier remarks, that it is the privilege of genius, 
to see in its dreams, what the humbler race of men, 
can ascertain by laborious vigils, and accumulated 
researches alone. 

And again, Professor Chapman observes: "as 
well might we compare the mere fluttering of the 
meanest and most grovelling bird, with the bold 
and well sustained flight of Jove's own imperial 
eagle, as the slow process of a vulgar intellect, by 
which facts are collected or observed, with the 
vigorous sallies of speculative genius, which seize 
truth as it were by intuition, and reveal it in a 
burst of light of celestial brightness." 

Although the medical libraries of most men, 
contain many volumes upon the cause, nature, and 
treatment of Consumption, little has been done, to 
put either the pathology or therapeutics of the 
disease, on a satisfactory basis, — its treatment, 
therefore, though variable, is by no means suc- 
cessful ; to remedy this state of things, and place 



INTRODUCTION. 11 

Consumption on the list of curable diseases, has 
been my aim for many years, — and by this treatise 
I shall give to the public at large, a list of cured 
cases, with their history and nature, known only 
heretofore in my private practice. I have delayed 
this work for the purpose of establishing beyond a 
possibility of doubt, the truth of what I now 
assert, Consumption can be cured. 

The mortification and degradation I feel, at the 
utter inefficiency of our art, in this the most com- 
mon of all diseases, is in itself sufficient stimulus 
to the work I am now engaged in, — but I have a 
higher object, that of mitigating human suffering, 
— to this end I have labored for years, " and what 
I conceived my duty, has been my reward." 

The vast number of cases that die annually in 
this and other countries through Consumptive 
disease is a melancholy truism, although its extent, 
familiar as it might appear, is very little known. 
The common estimate gives one fourth of the 
deaths, which annually occur as consequent on 
Pulmonary Consumption. But it will be seen by 
reference to our statistics that this is incorrect. 
And that when we add to our estimate the many 
diseases that emanate and finally terminate in 



12 INTRODUCTION. 

Consumption, we shall find the number vastly 
increased. 

Though much attention has been bestowed on 
this subject, by many distinguished European 
authors, Laennec, Andral, Louis, and many others, 
we find little certainty arrived at in the treatment 
of Consumption, until Professor Ramadge, ot 
London, declared to the world its curable nature. 
When his work appeared I determined to stem the 
current of public opinion on this side the Atlantic, 
and prove what I have long asserted in private 
practice, that the general treatment relied on in 
this country is inefficient, and its result always 
uncertain. Dr. Young, of St. George's Hospital, 
says : " it is probable that without assistance, not 
one case in a thousand of the disease would re- 
cover ; and with the utmost power of art, perhaps 
not more than one in a hundred will be found 
curable." Now out of one hundred and twenty 
seven cases treated by me in the last seven years, 
sixty three were cured, seventeen died, (above 
the age of fifty years) and forty seven were incur- 
able from the extent of disease, having tubercles 
on the coats of the bowels, and consequent diar- 
rhoea. 



INTRODUCTION. 13 

It is when this state of the bowels takes place, 
that 1 consider the patient in a critical situation, — 
and not when the cough, expectoration of blood, 
or matter, or both, have alarmed the sick man or 
his friends. These are only the symptoms of the 
disease that we profess to cure, and should never 
be looked upon as unfavorable ; add to these night- 
sweats, a hectic flush, debility, and emaciation, 
and you only have the disease in question, Con- 
sumption. 

Now whether this state be the result of a ne- 
glected, or predisposed constitution, or a badly 
treated pneumonia, or pleurisy, or any other 
actively inflamed state of the lungs, where proper 
depletion has been omitted the effect is the same, 
abscess or softened tubercles, expectoration of pus, 
sometimes streaked with blood, and hectic fever. 

These are the symptoms belonging to that disease 
authors have named phthisis puimonalis ; when it 
occurs as a sequel of other diseases, especially 
those above cited, 1 am decidedly of opinion that 
the neglect of early, well timed, and proper de- 
pletion, is in every instance the cause ; this fre- 
quently happens from the delay of the patient 
in calling his medical adviser. 

1 cannot believe there are many medical men 

2 



l4 INTRODUCTION. 

among us, in the present enlightened state of our 
science, unacquainted with the importance of the 
bold and repeated use of the lancet, in the continued 
form of fever which accompanies pneumonia, or 
pleurisy. The time to lay down the lancet, will 
be when the patient ceases to complain of pain, or 
oppression, and can lay on either side with ease. 

If, however, from timidity, or any other cause, 
bloodletting should not have been timely and 
freely used, the disease goes on unmolested, and 
soon arrives at that point surgeons have designated 
the third stage of inflammation, suppuration and 
abscess.) The fever now assumes another form 
from continued ; it intermits, and soon puts on the 
hectic character. The abscess bursts, expectoration 
of blood and matter follow, and the patient is said 
to be in consumption. The same results from the 
ripening, softening, and bursting of tubercles. 

The constitution in which tubercles are most 
frequently met with is marked by a scrofulous 
idiosyncracy. The blood gives off its carbon 
sparingly, in consequence of the delicate tissue, 
lining the air cells, being loaded with a tenacious 
mucus ; thereby preventing the free transmission 
of the gases. Oxygen and nitrogen inward, and 
carbonic acid outward. The blood in this case 



INTRODUCTION. 15 

undergoes a change, from a healthy to a diseased 
condition, its carbon is retained, and congestion is 
the result. 

In this state of things, if the venous system be 
not relieved, by full and proper depletion, we shall 
soon have mother nature (the vis medicatrix 
natura,) acting for herself, and consequently a 
ruptured blood vessel. 

I see in looking over the thirty-sixth number of 
the American Journal of Medical Sciences, for 
August 1836, the experiments of Dr. Robert E. 
Rogers, which must go far to prove the correctness 
of the position 1 have advanced above. 

I have taken the liberty of copying one of his 
experiments. 

"A small bladder, not long taken from a pig, 
was filled with fresh venous blood, when it was 
closed, and suspended by a thread from the cover 
of a tall receiver, which fitted air tight. The 
receiver, standing over mercury, was then filled 
with oxygen, and in two hours the mercury in the 
bottom of the receiver was considerably depressed. 
Upon inspecting the contained air, a very sensible 
quantity of oxygen had disappeared, but was 
replaced by a still larger amount of carbonic acid, 



16 INTRODUCTION. 

the excess of which explained the depression in 
the mercury. 

" This experiment was varied, by making trial of 
other gases, as hydrogen, nitrogen, and bicarburet- 
ted hydrogen ; and in every case with the develope- 
ment of carbonic acid. 

"In order to ascertain if, during this evolution of 
carbonic acid and disappearance of the other gases, 
any elevation of temperature ensues, an apparatus, 
such as may be seen at page 297 of the August 
number for 1836, of the American Journal of 
Medical Sciences, was made use of. Using my 
form of Sanctorio's thermometer, it was plunged 
to the bottom in a bag consisting of membrane, 
and full of blood, the bag being tightly secured at 
the neck, and suspended in an atmosphere of 
oxygen. In this instance the result was in a high 
degree satisfactory. 

" A considerably greater rise of temperature was 
manifested, proceeding no doubt from the influ- 
ence of the absorption of oxygen and the trans- 
mission through the membrane of carbonic acid. 

" Let us now recapitulate the leading facts de- 
veloped in regard to the evolution of carbonic acid 
from venous blood. 



INTRODUCTION. 17 

" 1st. Exhaustion by means of the air pump has 
no effect in evolving carbonic acid from venous 
blood. 

"2d. A temperature of 212° displaces no car- 
bonic acid from venous blood. 

" 3d. The carbonic acid on the other hand, is 
absorbed by exposing it to venous blood. 

" 4th. Exposing venous blood to oxygen, nitro- 
gen, hydrogen, and nitrous oxide, though each of 
these if we except hydrogen, is in part absorbed, 
yet not a particle of carbonic acid is given off. 

"5th. When, however, a portion of venous blood 
is placed in a bag of some membrane, and the 
whole immersed in an atmosphere of some gas, 
oxygen, hydrogen, nitrogen or bicarburetted hy- 
drogen, (others have not yet been tried,) then 
carbonic acid is pretty freely evolved." 

These experiments solve completely the problem 
of respiration ; and I may add, clearly account for 
loss of colour always met with in persons having 
a slight catarrh. The extensive membrane of the 
lungs being coated with mucus, prevents the 
transmission of oxygen to the blood, and hence the 
loss of colour. The inhalation of the vapour of 
warm water to which a small portion of gum 
ammoniac had been added, would always relieve 

2* 



18 INTRODUCTION. 

this state of things, without sickening the stomach 
with nauseous mixtures of squills, antimony, 
candies, lozenges, and such like things — the use 
of which most frequently end in sending for a 
physician. 

But we will suppose this cold neglected for a 
long time, until nature makes an effort to relieve 
herself. She forces on the thickened mass of blood, 
the heart and arteries labour, fever commences, 
the fibrin becomes diseased, and consequently 
deposits minute masses, the nucleus of tubercles. 
The skin becomes permanently white, the con- 
junctiva pearly, and the individual is prepared for 
Consumption, unless some obstruction takes place 
in the windpipe, or the tonsils enlarge, to prevent 
the escape of the air, and swell the cells of the 
bronchea, — breaking the adhesion of mucus, and 
again exposing the membrane to the action of a 
fresh portion (oxygen, nitrogen, &c.) of the atmos- 
phere. In this case the individual gradually re- 
turns to health. 

But in the scrofulous habit, where tubercles 
exist, they increase, and may be seen multiplying 
on the sides of the neck, and under the scalp. I have 
removed some hundreds of them in this situation, 
and find them to contain the same cheese-like 



INTRODUCTION. 19 

matter always met with in the lungs of those who 
die of Tubercular Consumption. 

A curious case of this kind occurred to me 
about six years ago, which will go far in my 
opinion, in support of my theory of Consump- 
tion. , 

This patient was the daughter of a lady who 
had died of Tubercular Consumption under the 
care of Dr. S. Jackson, the present professor of the 
institutes of medicine in the University of Penn- 
sylvania. I think I may say without the fear of 
contradiction, that the practice he pursued in her 
case prolonged her life, — she was above fifty-five 
and died in her sixtieth year. She left daughters ; 
one of these was soon after attacked with hae- 
moptysis, which greatly alarmed her, and conse 
quently produced the most unfavourable forebod- 
ings in her mind ; Dr. S. Jackson was again called 
and took charge of her health, her symptoms im- 
proved for a time, but she died in about eighteen 
months from her first attack. 

Her younger sister was soon after attacked with 
the same symptoms. She ruptured a small vessel 
and spit blood freely, and determined at first to 
let nature take her course. But her attacks were 
frequent and debility alarmed her. Thus situated 



20 INTRODUCTION. 

she applied to me in March, 1835, I found by per- 
cussion and careful auscultation that the summit 
of each lung was obstructed by tubercles ; several 
existed on the sides of the neck, and more than 
thirty under the scalp. I removed the most of 
these tubercles wit^i the knife, and at once com- 
menced the general treatment. 

I gave her full assurance of a speedy convales- 
cence, and the history of her case, under the head 
of cases, will show how far I kept my promise. 

There are few anatomists unprepared to admit 
with me, that tubercles are most frequently, if not 
always found in consumptive habits, in the ex- 
treme summit of the lungs, where from the physi- 
cal structure and consequent formation of the 
chest, portions of the lungs thus situated, are denied 
that free expansion in inhalation which other parts 
enjoy. 

Now this state of things can be prevented by 
mechanical means, and this naturally compressed 
part, be brought, to participate in the full and com- 
plete inflation enjoyed by other portions of the 
parenchyma, more favourably located for the pinv 
poses of life, 



CAUSES OF CONSUMPTION 



Hereditary predisposition has been consider- 
ed by many authors as a cause of the most formi- 
dable character, a cause that no treatment or care 
can avert, and of which all who have unfortunately 
inherited it, must feel the blighting influence. 

The fallacy of this opinion I am fully prepared 
to prove. Cases of this nature have been abun- 
dant in my private practice. I shall detail several 
of them through this work, and show how far the 
physician may be able to remove the predisposi- 
tion, and make good constitutions out of bad mate- 
rials. 

The constitution of man is framed by what it 
feeds on. 

The infant born to die of Consumption, if taken at 
an early age from the parent, and far removed from 
all her peculiarities, her milk, her careful housing 



22 CAUSES OF CONSUMPTION. 

her exposed mode of dressing, her hot chambers, 
&c. loses in an astonishing manner those constitu- 
tional imperfections, which might otherwise (being 
engrafted,) take root and flourish to its destruction. 
I have seen many cases, I admit, where children 
have been born perfectly healthy, and being 
nursed by the mother for two or three months, 
loose flesh, become marasmatic, dwindle and die. 
But the same mother, having a second child, de- 
termined upon my suggestion to employ a healthy 
wet nurse, when the result was the reverse. 

It happens occasionally, though rarely, that the 
foetus in utero may have tubercles, and the greater 
portion of the parenchyma rendered unfit for the 
purposes of respiration. This seldom occurs, how- 
ever, for great nature has so arranged the foetal 
circulation, that the lungs are protected in a re- 
markable manner from the deposit, which neces- 
sarily precedes tubercles. I have frequently met 
with tubercles in the placenta, but not often in 
the lungs of the foetus. 

Hereditary Consumption more frequently occurs 
from a general constitutional contamination, de- 
ranging the circulating mass of blood, and thereby 
rendering the deposit of tuberculous matter certain, 
pnless a complete change is made in the mode of 



CAUSES OF CONSUMPTION. 23 

living. Let the infant be reared by a nurse in 
constitution the opposite in every particular of its 
mother, and the adult forsake all her habits of 
former life when Consumption threatens invasion. 
In vegetable life, you can so change the soii as 
completely to arrest the growth, and finally de- 
stroy the plant. So in Consumption, you may 
alter the constitution of the infant to a degree 
in which a consumptive diathesis cannot exist. 

A supposed predisposition is not an unfrequent 
cause of Strumus Consumption. When the indi- 
vidual who may be the subject of disease of the 
lungs, has contracted severe pneumonic inflamma- 
tion, it frequently happens that they rely on lozen- 
ges, cough mixtures, plasters, pediluvium, or some 
hocus-pocus for some days before sending for a 
physician, or when they do send for a physician, 
they may select one who considers active remedies 
dangerous in such constitutions, and the inflam- 
mation is allowed to pass through the several 
stages, until suppuration and abscess are the re- 
sult. 

I attended a family in this city some years ago, 
who had (under the care of their former physi- 
cian) lost three infant children, one at the age of 
ten months, the second at seventeen months, and 



24 CAUSES OF CONSUMPTION. 

the third at three years. They were all nursed by 
the mother for nine months, and carefully fed from 
that time, principally on farinaceous articles, until 
teething was completed. The third, living some- 
what longer than the others, was allowed some 
animal food. 

At the expiration of the third year she had a 
severe attack of croup, from which she recovered 
with the usual treatment ; one week after her 
recovery she was taken out, and contracted (ac- 
cording to the account I had of her case) a slight 
cold, she coughed frequently, with occasional crying 
spells after each attack of coughing ; in the course 
of a few days some fever was evident, and the 
family physician was called to prescribe for her. 
He gave her an expectorant, mixture of squills, 
paregoric, and spirits of nitre, and directed her 
bowels to be kept open with senna. The little 
sufferer improved but slightly, sometimes fretful 
and uneasy, and now and then amused for a short 
period with her toys. 

This milk and water treatment was persevered 
in until the inflammation, fever, and cough became 
continual; the patient was now pronounced, like 
the former children, in a rapid decline. 

The mother having heard that I had asserted 



CAUSES OF CONSUMPTION. 25 

Consumption was curable, determined I should be 
sent for; this was done, and I saw the child eight 
hours before its demise, nature had relieved herself 
by effusion and the patient soon expired. 

I requested permission to examine the body; 
this was granted, and I proceeded to the autopsy 
twelve hours after death. 

The brain was found in a healthy state ; the 
stomach distended with flatus ; the bowels in the 
same condition, except the excretories on their 
surface, which were much congested. The blood- 
vessels of the liver, larger than natural. The heart 
in a perfectly natural state, with rather more fluid 
in the pericardium, than is generally met with at 
the age of this subject. The cavity of the chest 
was next examined. The pleura exhibited much 
inflammation, with many points of adhesion. The 
exterior surface of the lungs was thickly beset with 
small hydatics, and more than three ounces of 
serum was found in the cavity of the pleura. The 
parenchyma was not yet exposed to view. I hesi- 
tated a moment at this stage of the examination — 
until my friend (the family physician) asked why 
I did not proceed. You are aware, Doctor, said 
I, upon my next incision depends my professional 
reputation. I have told you already, that this 

3 



26 CAUSES OP CONSUMPTION. 

child had no tubercles — now if they should exist ? 
Then, said the doctor, I shall say nothing about 
your opinion. No, said I, if they do proclaim me 
ignorant, but if they do not, believe no more in 
the necessity of children dying of consumption, 
who have the misfortune to have been born of pa- 
rents said to be predisposed to that disease. 

The parenchyma was now cut into, and that 
state of things only found, which is always met 
with after death from pneumonia. No tubercles 
existed. 

In the course of two years the lady had another 
child, which is now well and very healthy, although 
it has passed through two or three severe attacks 
of pneumonic inflammation, where the lancet was 
not spared. 

From what I have already said, it must appear 
evident, that I consider inflammation of the lungs 
erroneously treated — a very frequent cause of ab- 
scess and consequent consumption, from the simple 
fact, that when remedies are not properly directed 
or judiciously administered, (the result being un- 
certain,) the lungs become engorged with venous 
blood, their mucous membranes transmit little or no 
oxygen, and abscess, or tubercles, are the result. 

The causes of consumption are either abscess or 



CAUSES OF CONSUMPTION. 21 

tubercles, produced by a depraved state of the 
blood, which may be occasioned by a long spell 
of moist or rainy weather, in which the atmosphere 
becomes too light to expand the air-cells of the 
lungs ; by a debilitated constitution, brought about 
in various ways, either by poor living or weak 
digestion, or by many constitutional diseases ob- 
structing the free circulation of the arterial blood. 

Dyspepsy, diseases of the liver, of the spleen, 
mesenteric glands, or of the heart, may all be cited 
among the causes of consumption. But as we 
consider all these diseases manageable, they can- 
not be called formidable causes. 

Jlmenorrhoza and dysmenorrhea are decidedly 
more so, and therefore, call for our prompt atten- 
tion. 

As these causes occur long before the thoracic 
derangement can be produced by them, they conse- 
quently should not be admitted by the judicious 
practitioner, but removed before consumption can 
be produced. 



28 



OF AUXILIARY 

CAUSES OF CONSUMPTION. 

Tight lacing has been hinted at by many writers 
of high repute, as a cause of not unfrequent oc- 
currence. By this abominable practice, most fre- 
quently met with in large cities, thousands are 
annually sent to a premature grave. Nature is 
cramped, confined and shaped to suit the taste or 
style of some mantua maker or other, until the 
respiration which should be performed by the pec- 
toral muscles, is compelled to be abdominal, un- 
less fashion varies, and the lacing puts these 
muscles also in a quiescent state. In that case, 
free respiration will be found to exist only in the 
upper portion of the chest. 

In the prevalence of short waists or high skirts 
in the dress of the ladies, when death occurs from 
consumption, it will be found that tubercles occupy 
the upper portion of the parenchyma ; and 
when the fashion alters to long waists, the lower 
portion of the lungs will be their seat. 



CAUSES OF CONSUMPTION. 29 

Now these facts speak volumes for the theory I 
have advanced in this work, on the subject of vo- 
luminous lungs — a theory upon which my practice 
is based, and supported by every day's experience. 

This practice of lacing not unfrequently binds 
the longitudinal muscles of the back also, in such 
a manner, that one side or the other must give 
way, and lateral curviture of the spine be the ine- 
vitable consequence. The lung of the affected 
side becomes compressed, a free passage of air is 
prevented from penetrating its cells, and conse- 
quently tubercles must follow. 

My success in the treatment of the so-called 
spine affections, is too well established in this city, 
to admit of these notions being called theoretical. 

Mothers, if you value the lives of your fair 
daughters attend to these matters, for although 
the brain may escape uninjured, the spine and 
lungs never can. Remove all obstacles that may 
tend to impede that useful and beautiful phenome- 
na of nature, respiration, and my word for it, the 
number of victims to the sad destroyer consump- 
tion, will daily diminish among that fair portion 
of creation for which man only lives to cherish and 
protect. 

Wet and cold feet are very frequently produc* 

3* 



30 CAUSES OF CONSUMPTION. 

tive of lung affections. There are few ladies in 
our city attentive to this matter, their feet and 
ankles are thinly clad, and consequently cold, 
while their bodies are well protected, and their 
neck and shoulders loaded with furs. The conse- 
quence is, a continual moisture of the neck and 
chest, and great liability to inflammation of the 
lungs, from a sudden check of this unnatural de- 
gree of perspiration. 

I have always recommended my patients to 
harden this portion of the body, (if I may be al- 
lowed the expression) by bathing the bust and 
neck night and morning in cold salt water, and in- 
stead of wearing as much clothing on this part as 
can be borne, to wear as little as they can be com- 
fortable with, keeping the feet and lower limbs 
well protected with thick shoes and stockings 
during the fall, winter and spring months. 

During the coldest of winter weather, a thick 
double veil should be worn, and instead of running 
directly to the fire when you enter your dwelling, 
retire to your chamber to make the change from 
an out to an in-door dress; or if your chamber 
should be heated, let the change be made in the 
hall or some part of the building not supplied by 
hot air. Remain there ten or fifteen minutes, to 



CAUSES OF CONSUMPTION. 31 

enable the Jungs to bear the difference of tempera- 
ture, without feeling that sensation of oppression 
which few individuals are unacquainted with, who 
pass a winter in a cold climate. 

The present mode of heating most of our dwel- 
lings and public places by furnaces, greatly in- 
creases the risk we encounter of inflammation of 
the throat and lungs, by a sudden transition from 
cold to heat. 

Indifference to these hints may not produce 
tubercular consumption, but it will lay the founda- 
tion of a more unmanageable disease, bronchitis. 

It is from heated churches and offices that our 
ministers of the gospel suffer so much from bron- 
chitis, and not from preaching, — as has been 
imagined by many. Churches are now generally 
warmed by furnaces, the air therefore is hot before 
the congregation enter it, the number respiring this 
heated and consequently impure atmosphere, soon 
increase its temperature, while they exhaust its 
oxygen. You now see many individuals, before 
the service is half over, throwing off their cloaks 
or shawls, fanning and fidgeting, reminding us of 
animals under the receiver of an air pump partly 
exhausted. Some friend now opens a window or 
door and admits a current of cold, which relieves 



32 CAUSES OF CONSUMPTION, 

in a measure the general mass, but endangers those 
who may be seated near its entrance, from the 
previous highly excited state of the surface. But 
the preacher encounters still more danger, his 
situation is ten or twelve feet above the congrega- 
tion. Heat being disposed to ascend, he is 
surrounded by an atmosphere many degrees 
higher in temperature than that in which his 
hearers exist Here, if he escapes asphyxia, he 
cannot expose himself many months without 
bronchitis. 

If this state of things was produced by public 
speaking, how is it, let me ask, that our auctioneers, 
our sea captains, or our lawyers, are not more 
frequently the subjects; their lungs are as often 
called upon to perform perhaps a more arduous 
and longer continued duty — but our court or auc- 
tion rooms, are not often crowded, and if they are, 
the mass of people are continually going in and 
out, and consequently, admitting fresh air with 
every fan of the door. 

Churches are, on the contrary, kept warm or 
hot, and the doors closed, unless some one being 
overcome, is led out for fresh air, relieving those 
who may be located near the opening. 

This accident by no means benefits the pastor, 



CAUSES OF CONSUMPTION. 33 

his situation is fixed for two hours at least, and if 
he be not positively exhausted, and faint, he is 
allowed to breathe the fresh atmosphere, only after 
the lining membrane of the air tubes of his lungs, 
have by this continued excess of heat been pre- 
pared to -put on inflammation. 

But the sea captain or his healthful crew, breathe 
no atmosphere like this. The air they respire, is 
warmed by the sun's genial ray; their home, walled 
by the horizon, and roofed by the blue vault of 
heaven. In their constitutions, you seldom meet 
with bronchitis, or consumption, and their voices, 
like trumpets, are heard afar. 

This state of things, always met with in the sea 
faring man, I own is sufficient to induce all who 
are threatened with Consumption, to try the ocean 
wave. And if this is done before it becomes too 
late for exercise, I have little doubt that many, who 
could participate in the duties of the sailor, might 
be much benefited by a sea voyage. 

I would by no means, however, recommend a 
sea voyage, to the individual who is expectorating 
pus freely, or may have hectic fever. To over- 
come this, a careful and well directed home treat- 
ment is indispensable, the privations on board of 
ship are too great to obtain the attention and care 



34 CAUSES OP CONSUMPTION. 

required. And it generally happens that the voy- 
age to sea, is the last remedy recommended, and 
consequently produces no beneficial result. 

The reason must be obvious; the debilitated 
individual is perhaps unable to leave the cabin, 
and the air of this, is little better (if at all,) than 
that of their own chamber, with less of home 
comforts. 

Or if their strength should enable them to be 
on deck, they are prevented either from want of 
inclination, or from the directions of their physi- 
cian, from participating in those healthy exercises 
of the sailor, upon which the benefit of a sea voyage 
depends. He is pulling and hauling continually — 
frequently making full and deep inhalations, and 
often for moments holding his breath, to enable 
him to concentrate all his power for the accom- 
plishment of some difficult task, consequently fully 
inflating the parenchyma, and thereby rendering 
himself exempt from obstructions in its circulation 
producing Consumption. 

Nor is the mariner the subject of bronchitis, 
his throat and neck is continually exposed to all 
the vicissitudes of the atmosphere, and like his face 
and hands, will always be found florid and 
healthy, no debility of the cuticular circulation 



CAUSES OF CONSUMPTION. 35 

will here exist, to invite disease, and consequently 
he escapes most if not all the throat affections. 

To see physicians at this time of vast improve- 
ment in medical science, recommending thick 
stocks, boas, pieces of flannel, and the wearing 
long beards, as a protection from disease, excites 
in me a smile ; when all should be done to harden 
and accustom those parts to exposure. 

The mariner or common labourer on shore, is 
unacquainted with bronchitis or chronic inflamma- 
tion of the throat. They wear no stocks or pads 
about their necks, on the contrary, you will 
generally find them with this part exposed, and 
like their faces, a lively circulation through the 
skin, giving that florid hue, the true criterion of 
health. 

Consumption is never met with in the savage, 
whose mode of life causes him to encounter the 
most severe weather, half clad. He sleeps on the 
ground, frequently with nothing under him but 
his blanket, and escapes taking cold, (as it is 
called,) because his skin is hardened to his mode 
of life. 

Many who travel among the Indians, without 
reflecting on their manner of living, attribute the 



36 CAUSES OF CONSUMPTION. 

good health they enjoy to their knowledge of the 
medical virtues of the roots, leaves, and bark, of 
the forest trees. This is not the case, however, 
for although some of the best of our botanic medi- 
cines are found in the far west, the Indian gathers 
them not for his own use, but for trafiic. His con- 
stitution requires little or no remedial art, in most 
of his diseases nature operates for herself; in catarrh 
some little obstruction may take place in the bron- 
chial tubes, but the volume of his lnngs is only 
increased. His shoulders are not tied down with 
straps to keep up his pantaloons, secured from 
raising by being fastened beneath his shoes : his 
lungs are allowed full play, and consequently their 
circulation not being obstructed in any manner by 
his clothing, he soon finds himself free from all his 
thoracic or throat affection. 

Not so however in civilized life, here we find 
broad suspenders on the clavicle, and strong leather 
straps to keep the pants from raising up, fixed 
under the boot, with frequently large stiff plasters 
over the breast and back, tied down by a tight net 
shirt, tight vest, and not unfrequently a large stiff 
stock reaching the chin, and thus a full inflation 
of the parenchyma is most effectually prevented. 



CAUSES OF CONSUMPTION. 37 

Can any one be surprised at the production of 
disease under these circumstances ? Ask nature 
— the result must be obstructed respiration, ob- 
structed circulation, inflammation, adhesions, tuber- 
cles, abscess and death. 



SYMPTOMS OF CONSUMPTION. 



It has long been acknowledged by the most 
learned in the medical profession, that the symptoms 
of phthisis pulmonalis are so variable and uncer- 
tain, the disease may be irremediably fixed, before 
the individual or physician has the most remote con- 
ception of its nature ; and the first intimation the 
invalid may have of his situation, perhaps will be 
a ruptured vessel and consequent hsemoptoe. Since 
the introduction of the stethoscope, most if not all 
the members of the medical profession, have be- 
come more enlightened on the subject of diseases 
of the lungs; and if applied to early in their 
course, can in general foretell what must certainly 
happen. 

The credit of introducing this instrument to 
Americans belongs to Professor Jackson, of our 
city, whose indefatigable zeal for improvement, 



40 SYMPTOMS OP CONSUMPTION. 

has done more for the art of discrimination in 
diseases of the chest, than any other physician on 
this side the Atlantic. 

Had his practice proved as certain as his know- 
ledge of the nature of Consumption, little would 
have remained for others to accomplish. His suc- 
cess has been much greater, however, than that of 
any of his predecessors, and his head deservedly 
crowned with laurels. 

Hippocrates had no doubt made use of auscul- 
tation, as is proved by reference to his writings : 
" you shall know by this that the chest contains 
water and not pus, if in applying the ear during 
a certain time on the side, you perceive a noise 
like that of boiling vinegar." Auscultation, there- 
fore, is not a recent discovery, but its application 
has been much improved by some of the French 
physicians. " Render to Caesar, that which is Cae- 
sar's." 

The general external signs of Consumption, few 
accustomed to observation can mistake; a de- 
jected expression, sharp features, shining eye, con- 
tracted chest, thick and projecting lips, and not 
unfrequently a slight anterior curvature of the 
spine. 

As the disease advances, we find a slight cough, 



SYMPTOMS OF CONSUMPTION. 41 

hectic blush at some period in the day, but gene- 
rally for the most part a very pale smoke, or lead 
color of the skin, with a livid, or vermilion lip, a 
red dry tongue, evening chills, followed by fever, 
terminating in night sweats, and free morning 
expectoration. These continue for a longer or 
shorter period, until finally, (without proper treat- 
ment) the individual succumbs. 

Cough is by no means an unequivocal symptom 
of phthisis ; this maybe produced from congestion 
of the liver, crudities in the primse vise, foreign 
substances, smoke, dust, certain gasses or fumes, 
or from elongation of the uvula, these may all 
occur without the least disturbance of the healthy 
action of the parenchyma. The removal of such 
causes soon puts an end to the cough, without 
disturbing the stomach with nauseous mixtures of 
syrups or candies. I witnessed a few years ago 
a remarkable case of this kind occurring in the 
family of a respectable merchant of New Orleans. 
His youngest daughter was taken during the 
winter season, (while in Philadelphia,) with severe 
cynanche-tonsilaris or inflammatory sore throat ; 
this continued for some weeks, although her physi- 
cian used, (as he supposed) very proper and ener- 
getic treatment. The child improved after being 

4# 



42 SYMPTOMS OF CONSUMPTION. 

for some time confined to her chamber, and at the 
expiration of two months was allowed as much 
fresh air as she could get by being well bundled 
up and put into a close carriage ; her health im- 
proved a little by this slight change from her 
heated chamber, but not sufficiently to satisfy her 
parents ; another physician was consulted, and 
they determined the patient should go home to 
New Orleans. When she arrived there, the best 
medical advice the place afforded, was obtained ; 
the child was now considered in a rapid decline ; 
her cough was incessant, she was bled, cupped, 
leeched, blistered, and well dosed, for several 
months, but still the stubborn cough kept on. 
The anxious parents watched every dose of medi- 
cine, every blister, every change of expression, to 
see some improvement, but alas none appeared. 
At length they determined, that if their daughter 
lived until the sailing of the next packet, they 
would take her back to Philadelphia, and consult 
Dr. Physic; this was done, and the doctor soon 
discovered the whole cause of her suffering ; 
great elongation of the uvula. Dr. Physic removed 
this cause by one stroke of the scissors, and all the 
alarming symptoms of Consumption vanished. 
How much distress and unnecessary pain would 



SYMPTOMS OF CONSUMPTION. 43 

this little sufferer have escaped, had auscultation 
or percussion, been used by her first physicians ; 
her lungs had nothing to do with the cough, which 
circumstance would have been at once discovered 
by the stethoscope. Well might this patient ex- 
claim, "throw physic to the dogs, I'll none of it," 
and how often is our materia medica taxed to per- 
form, that which belongs to the better judgment of 
the physician. 

I have heard of senna and salts being given 
every other day for a period of six months, to cure 
a pain in the lower part of the abdomen, when this 
was produced by irritable uterus, and the symp- 
toms much aggravated by the course, all yielding as 
soon as proper remedies were used ; and yet both 
these articles are valuable in their proper place. 
But to return to my subject. Haemoptysis has 
been looked upon by many as a cause of Consump- 
tion, and this opinion appears to have gained 
ground so rapidly that few are prepared to believe 
their physician when he declares its existence 
should not alarm the individual who may be at- 
tacked with spitting of blood. The confidence 
must be great indeed if his assertion has the effect 
of allaying all their fears; now, although hae- 
moptoe may cause great alarm, and occasionally be 



44 SYMPTOMS OP CONSUMPTION. 

an unfavourable symptom, this is by no means 
always the case. It may occur in a slight catarrh, 
from local plethora of some minute vessel of the 
lining membrane of the bronchia, and be of no 
more importance than bleeding from the nose, in 
consequence of fullness of some of the small ves- 
sels of the Schneiderian membrane. In most 
cases, we may consider spitting blood a favoura- 
ble sympton, often relieving an unpleasant weight 
or fulness in the breast, and frequently terminating 
the most alarming diseases, as pleurisies, peripneu- 
monies, fevers, &c. &c. 

The history of one of our most, respectable 
members of society, the late Joseph Watson, 
former mayor of this city, may not be generally 
known to many of our readers ; I therefore, take 
the liberty of introducing an account of a portion 
of his life, to prove that haemoptysis should not 
always be looked upon as an alarming symptom. 

About the year 1810, Mr. Watson was employ- 
ed in the counting-house of my father-in-law, 
(Chandler Price, Esq.) who became much alarmed 
for his safety, in consequence of his having a con- 
tinual cough, free expectoration mixed with blood, 
and frequently attacks of hsemoptoe ; debility and 
emaciation soon took place, and in less than six 



SYMPTOMS OF CONSUMPTION. 45 

months Watson was called a walking skeleton. 
Dr. Physic was consulted in his case, and finding 
that he was determined to try riding on horseback, 
gave him the best directions he could follow under 
the circumstances : he was to make short stages, 
to be well protected from the weather, to eat 
sparingly, to keep the bowels open daily with a 
mild pill of rhubarb and aloes, and never to sleep 
in a strange bed unless the sheets and blankets 
had been well dried the day previous. 

With these directions our friend set off for New 
Orleans on horseback, I believe in the latter part of 
the summer of 1811. The first day he reached Old 
Chester, fifteen miles, on the second of his journey 
he had some spitting of blood, but made out to get 
as far as Wilmington, where he remained two days 
in consequence of bad weather. The eighth day 
he arrived at Washington, where he again spit up 
some blood after a violent spell of coughing. He 
persevered on his journey, making short stages, 
and finally reached New Orleans after travelling 
twelve weeks, much improved in his appearance, 
strength, and spirits. 

He had no return of haemoptoe after he left 
Washington, and his cough gradually subsided, 
being entirely free from it, in about six weeks 



46 SYMPTOMS OF CONSUMPTION. 

after leaving his home in Philadelphia. Early 
in the summer of 1812, he returned home by- 
sea in fine health, and much improved in flesh; 
he continued to increase in size gradually for some 
years until his weight became the only cause of 
complaint, having no return of his old disease 
since leaving Washington in the last of September 
1811. He died of hydrothorax in 1841, at the 
age of sixty years. 

The general healthy appearance of Mr. Watson 
must be familiar to most of our citizens. Had he 
remained at home and continued the sedentary 
employment of book-keeping, he would no doubt 

have died in the course of two or three years from 
the supervening of phthisis. Many cases of this 
kind have occurred, where from neglect of exer- 
cise, digestion, and full inflation, hsemoptoe has run 
on, and Consumption been the result. This may 
always be prevented, and the individual who 
neglects his constitution under these circumstances 
pays dearly for his folly. 

Various nostrums, candies, lozenges, etc., de- 
serve notice under this head of auxiliary causes of 
Consumption. 

Most if not all the popular compounds for cough 
contain opium in some form or other ; they conse- 



SYMPTOMS OF CONSUMPTION. 47 

quently relieve one of the symptoms of lung affec- 
tions, while they increase in most cases the cause 
of many others, by producing constipation and 
consequent derangement of the liver. Few per- 
sons apply to physicians until they have swallowed 
all the quackery within their reach, and their 
bowels locked up ; this is certainly the case in this 
country, and prevails to a much greater extent in 
England. There is so much truth in these asser- 
tions, that the great Abernethy, (whose talent and 
extensive medical acquirement I shall always hold 
in the highest respect,) suspected the liver as the 
primary seat of Consumption, and consequently 
prescribed blue pill with some purgative, to be 
continued daily for months if there was no amend- 
ment. He no doubt found most of his cases with 
a previous confined state of the bowels; had mer- 
cury been omitted, however, and this great surgeon 
of Europe illumined by the same ray that lights 
the mind of Ramadge to the secret operations of 
nature's work in lung diseases, he would have 
removed the mischief done by nostrums, with 
milder means, and perhaps explored the chest. 

Professor Chapman in one of his clinical lectures 
at the old Philadelphia Almshouse in 1818, speak- 
ing of Consumption observed to his class, " as 



48 SYMPTOMS OF CONSUMPTION. 

well might the physician shoot a bullet through 
the heart of his patient in tubercular consumption, 
as administer mercury in any form." I think I 
may truly say, I have seen abundant proof of the 
truth of this assertion, in a practice of twenty 
years. 

The working class of our fellow beings are for 
the most part free from the impositions practised 
upon the human family by forged certificates of 
wonderful cures, for they have no means to sup- 
port quackery ; their simple catarrhs are not often 
interrupted, and consequently the chylopoetic 
viscera is undisturbed by these narcotic mixtures ; 
the bowels are free, and the mucous membrane 
soon pours out the offending cause, while the 
moderate contraction of the trachea always met 
with in catarrh oppresses the breathing, producing 
a voluminous state of the Jungs, the circulation 
thereby freely maintaining a healthy action 
throughout the whole body. 

There is no limit to the credulity of man, the 
most learned can be brought to believe, that, which 
sober reflection would condemn as false, until ma- 
turer reason claims control. 



STRUCTURE OF THE LUNGS. 



The different opinions which have been enter- 
tained by many anatomists in relation to the 
structure of the lungs, it may not be improper to 
mention, before entering upon the treatment of 
their diseases. It was imagined by Malpighi 
that the lining membrane of the bronchia divided 
to form air cells, like a sponge. But the experi- 
ments of Helvetius went to prove that the air cells 
were formed by a simple cellular tissue enveloping 
the various blood vessels of the lungs. The greater 
number of anatomists, Haller among the rest, have 
adopted the opinion of Helvetius. If we inject 
the blood vessels of a fresh young subject with 
wax, and at the same time fully inflate the air 
cells through the trachea, we can by careful in- 
cision, fully satisfy ourselves of the correctness of 
the views of Riesseissen, who proved the lungs to 

5 



50 STRUCTURE OF THE LUNGS. 

be formed by air cells and blood vessels, the 
former terminating in a kind of cul-de-sac. 

This natural structure of the lungs, while it so 
admirably adapts them for the office they perform 
in the support of animal life, renders them suscep- 
tible to many diseases, in a variable climate like 
ours. But as most of those diseases have been 
already mentioned, I shall now confine myself 
entirely to a description of the morbid condition 
met with after death from Consumption. 

Upon dissection of those who die of Consump- 
tion, we generally find that morbid state of the 
lungs which unfits them for the duties they are 
destined to perform for the purposes of life. Por- 
tions of the parenchyma will be found absorbed 
or changed into abscess, or its substance occupied 
by tubercles; or large adhesions may exist, or the 
greater portion of the lungs may be completely 
solidified or hepatized ; or great effusion may be 
dicovered in the cavity of the pleura, and the 
parenchyma so compressed, that respiration cannot 
be longer performed and death the inevitable re- 
sult. Or the surface of the air cells may put on a 
high state of inflammation, (acute bronchitis) and 
consequently be rendered unfit to perform the 
function nature has ordained for these parts, by 



STRUCTURE OF THE LUNGS. 51 

pouring out an abundant, thick and adhesive 
mucus, and thus effectually preventing the trans- 
mission of the gasses in respiration. The blood re- 
ceives no oxygen, its carbon is retained, and sent 
back to the heart, which soon becomes enfeebled, 
its action is consequently rendered weak and rapid, 
the pulse will increase in frequency while it grows 
weaker, the skin becomes livid or blue, and the 
individual is said to be suffocating. I consider 
patients thus situated in immediate danger, and 
believe there is no remedy but the lancet. I have 
seen hundreds of children thus situated restored 
by frequent and free depletion. In this state of 
things, the case will generally be called hopeless, 
but if the physician is experienced, and will bleed 
boldly, even to an extent that would be prejudicial 
under other circumstances, or in other diseases, he 
may produce some slight effusion from this lining 
membrane of the bronchia, washing away the 
tenacious mucus which block up its surface, and a 
free expectoration will frequently follow. 

Perhaps this page may meet the eye of my old 

and much esteemed friend G. S , Esq., one of 

our most respectable merchants ; should this hap- 
pen, he will no doubt remember the situation of 
his little daughter Sarah, whose case was very 



52 STRUCTURE OF THE LUNGS. 

similar to that above described ; free bleeding was 
repeated seven times, producing syncope after each 
operation, she soon recovered without general 
dropsy as was predicted by some of her friends. 

I am of opinion that the lancet seldom if ever 
produces dropsy, but much more frequently pre- 
vents Consumption. 






PROPHYLACTIC TREATMENT 



O F 



CONSUMPTION. 



One of the most powerful agents in preventing 
Consumption, is exercise ; and I may add, one of 
the best additions we can make to the use of inter- 
nal remedies, for its cure. Of the different kinds 
of exercise, perhaps running, and riding, are the 
best. We seldom or ever see Consumption as an 
original disease, in the young pupils of our com- 
mon schools ; there is no limit to the playfulness of 
boyhood; the respiration is frequent and deep, a 
large volume of air is admitted, favouring a healthy 
development of the whole parenchyma, while with 
the increased action of the heart and arteries, 
rapid decarbonization of the blood is the conse- 
quence, and health is less liable to interruption. 
From this constant and free supply of oxygen the 



54 PROPHYLACTIC TREATMENT 

animal heat is increased, the action of the heart 
becomes more vigorous, and all the glandular 
secretions carried on with greater energy. 

Sydenham was generally in the habit of recom- 
mending riding as an exercise of much value as a 
prophylactic, and perhaps it will be found that 
riding, may produce all the benefit of walking or 
running without the fatigue ; I have already given 
an instance of the great advantages arising from 
horse back exercise under another head, and its 
value is too well established to require repetition 
here. I shall, therefore, pass on to gymnastics, as 
a mode of exercise, particularly in the winter 
season, best calculated to assist the physician in 
restoring his patient to health, whose sedentary 
habits may demand something of this nature, or 
whose debility may prevent him from leaving his 
chamber. The most proper machinery for this 
purpose will be a pair of ladders ten feet high, set 
six or eight feet apart at bottom and firmly secured 
at top, and so braced that there shall be no risk of 
falling ; a pair of horizontal bars six or eight feet 
long supported on two stands, in such a manner 
that the individual exercising, may walk between 
them, and by placing his hands upon the bars, 
raise his body, by the action of the pectoral, and 



OF CONSUMPTION. 55 

other muscles, until the feet swing clear of the 
floor. This exercise, will generally be found to 
produce a glow, and give rise to a free circulation 
throughout the limbs ; I have often been called 
to visit patients, who were unable to raise the hand 
to the head, in consequence of great debility of the 
muscles, and after daily trial for two weeks, could 
perform many feats upon the ladder above de- 
scribed, raising the whole weight of the body from 
the floor to the great astonishment of all their 
friends. Strong ropes may be secured at opposite 
points, on the wall, to bear the weight of one or 
more persons at the same time ; upon these ropes 
so fixed, individuals may perform all the evolutions 
of a sailor, and in a short time obtain strength and 
a consequent free circulation in muscles, that might 
otherwise soon become comparatively useless. 
A remarkable case of this kind occurred in my 

practice in the fall of 1837. N. P , a young 

man, about twenty two years of age, was taken 
with pneumonia, from which he recovered under 
the use of the usual remedies ; — but the muscular 
power of his limbs remained so feeble, that he 
despaired of ever being able to leave his room : 
tonics and friction, with the most stimulating lini- 
ments, had no effect. Under these circumstances 



56 PROPHYLACTIC TREATMENT 

I determined to try the efficacy of exercise on the 
voluntary muscles, and at the same time recom- 
mended full and deep inhalation, and a consequent 
full expansion of the parenchyma ; a double ladder 
twelve feet high was made for his use, and at the 
expiration of three weeks 1 found him suspending 
his body from the top rounds by his hands, although 
at first unable to raise them above a level with his 
shoulders : he soon recovered his usual health, 
which he still continues to enjoy. 

The ancients no doubt were fully acquainted 
with the advantages derived from gymnastics; and 
consequently recommended these exercises to be 
particularly practised by those who might be des- 
tined to take an active part in their wars ; this they 
considered necessary, to produce that muscular 
strength required in the field of battle. War was 
a laborious occupation from the weight of the 
armour used by the ancients, and strength must be 
acquired by exertion, and supported by constant 
exercise. The gymnastic games were consequently 
connected with their religion, and victory in them 
was politically rendered an object of the highest 
importance. 

" Palmaque nobilis 



Terrarum dominos evehit ad deos." 



OF CONSUMPTION. 57 

The gymnastic art had attained no considerable 
degree of perfection in the time of Homer, as we 
find from the description of the games at the fu- 
neral of Patroclus. Gymnastics were introduced, 
however, into medicine only about the time of 
Hippocrates, or perhaps a little before his era by 
Herodicus, his father. The gymnastics of the 
warriors were too violent for the diseased, or even 
for the preservation of health in those not naturally 
strong ; and Hippocrates, in his work on regimen, 
speaks of exercise in general, of walking, of races 
on foot or horseback, leaping, wrestling, the cory- 
cus, or exercising the suspended ball, with the 
usual additions of unctions, frictions, and rolling 
in the sand practised in those days. Boxing, the 
pancratia, hoplomachia, running, quoits, the exer- 
cise of the ball, hoop, and javelin, required too 
great exertion to be admitted into the medical de- 
partment ; though walking, vociferation, recitation, 
and holding the breath, seem to have been among 
the medicinal exercises; — and by this holding the 
breath, we must conclude the ancients had some 
knowledge of the advantage arising from full in- 
flation of the parenchyma. Hoffman mentions 
fifty-five kinds of medicinal exercises, which I 
shall not enumerate ; Dr. Carmichael Smyth recom- 



58 PROPHYLACTIC TREATMENT 

mends swinging as one of the best modes of exer- 
cising ; he devoted a treatise entirely to this subject, 
in which he brought forward many proofs of its 
superior utility. I unhesitatingly recommend all 
the different modes, leaving their choice to the 
judgment of the physician ; but as the double 
ladder, the horizontal poles, the festooned rope, 
swinging weights in the hands, horseback riding, 
walking, running, and inflating the lungs, have 
done all for my patients that I could expect or they 
desire, I shall most certainly adhere in the gene- 
rality of cases to their use. 

I have known sterility entirely cured by atten- 
tion to some of these modes of exercise, thereby 
removing the debility of the nerves, which is in 
many cases the sole cause. 

The peculiar delicacy of constitution often met 
with in young married ladies, preventing their ever 
becoming mothers, arises most frequently from their 
sedentary habits. By constant attention to proper 
exercise and a mild local treatment, I have known 
many blest with the full enjoyment of all their 
wishes, when neglect of these matters would fre- 
quently end in bad health, the forerunner of Con- 
sumption. If we would wish to preserve good 
health in females we should attend to the harmo- 



OP CONSUMPTION. 59 

nious action of all the functions. To accomplish 
this end exercise is a powerful agent. 

If we extend our observation to the inferior 
animals, and observe the difference between the 
tame and wild deer, we shall be struck with the 
importance of exercise. I have found in the course 
of my inquiries, (and this has no doubt occurred 
to others,) that tubercles are never met with in the 
lungs of the wild deer, while they frequently exist 
in the lungs of the same animal, domesticated. 

Perhaps this cannot be better exemplified than 
by way of contrast, — swine, proverbially the most 
indolent of all animals, are the most subject to the 
tuberculous disease ; hence the derivation of the 
word scrofula, from the latin scrofa, a swine ; and 
Consumption and scrofula are often the same, both 
resulting from tubercles. 

I have introduced these facts as an argument in 
support of the importance of exercise — if that 
healthful prophylactic is properly attended to, I 
shall be fully repaid for all the trouble I have been 
at. I have thus far set before the reader, disease and 
a preventive; not life and death, these are the 
dispensations of a higher power. 



TREATMENT OF CONSUMPTION. 



If from neglect or improper treatment of any of 
the acute diseases already cited, or from a scrofu- 
lous constitution, Consumption should take place, 
our first effort should be directed to the cure of 
hectic fever. When this is completely accomplished 
we may proceed to the removal of its causes. 

It is this fever in Consumption that debilitates 
the patient, and not the expectoration, as has been 
imagined by many : we often find large ulcers on 
the limbs, called constitutional, discharging a great 
quantity of pus, and yet no hectic fever or debility 
is produced. The scrofulous habit is the most sub- 
ject to hectic. 

For the purpose of removing this form of fever, 
I have employed moderate anti-phlogistic means, 
with the most decided benefit in the majority of 
cases. Ramadge (it will be found by reference to 

6 



62 TREATMENT OF CONSUMPTION. 

his work,; directs for this purpose the application 
of a few leeches to the chest, I must differ from 
him a little, but only in locality. I have always 
found three or four ounces of blood taken from the 
back, immediately opposite the fourth or fifth dor- 
sal-vertebrae, either with leeches or cups, decidedly 
more efficacious. A few applications of this nature 

with the daily use of a compound pill 

will soon lessen or re- 



move hectic paroxysm, and prepare the patient for 
a course of inhalation. Weakness is seldom com- 
plained of, from this careful mode of depletion, 
while the relief is certain. Blood-letting in Con- 
sumption should never be carried to an extent that 
may cause reaction, unless it is used for this pur- 
pose solely, as in the case of indolent ulcer ; if 
practised under other circumstances, the fever in- 
stead of being relieved will be much increased. 
There are those no doubt in the medical profession, 
who have observed a sluggish ulcer discharging 
matter and remaining in the same state for months, 
immediately put on the healing or adhesive pro- 
cess, after some slight hemorrhage has taken place. 
Many surgeons have recommended the application 
of a few cups or leeches for this purpose ; and we 
frequently find the consumptive patient improve 



TREATMENT OF CONSUMPTION. 63 

after a slight discharge of blood from the lungs. 
Perhaps this apparent relief met with by all ob- 
servers, may have led many to the conclusion, that 
a removal of bleeding hemorrhoids was always 
dangerous to the consumptive individual. My 
opinion is, however, that this conclusion is erro- 
neous, and that it would in all cases be better for 
the physician to keep, if possible, depletion under 
his immediate controul, carefully watching every 
change in the system and being always governed 
by circumstances. 

Slight haemoptoe there is decidedly less risk, in 
leaving to nature ; this only occurs when idiopathic 
plethora requires depletion. 

When by this local depletion, the hectic parox- 
ysm is subdued, we must in the next place try to 
discover by attentive examination, the state of the 
constitution ; and find whether the ulcers or 
vomica, are indolent, inflammatory, or irritable : 
upon their nature, will depend the treatment. If 
indolent, and the patient complains of no pain or 
suffering, when coughing or upon full and deep 
inspiration, I would direct for the purpose of pro- 
ducing new action, — the inhalation of a mixture of 
such gasses as I have invariably found useful for 
the production of this healthy change; a brisk purge 



64 TREATMENT OF CONSUMPTION. 

of sulphur, super-tart-pot, jalap and iodine, should 
follow the use of the gasses, and the general me- 
chanical inhalation should commence, with a full 
and generous diet ; by these means I should expect to 
prepare the cavity for reunion and approximation. 
But should I find the abscess, of a painful charac- 
ter, the expectoration ichorous, and the inflamma- 
tion of the tongue and throat very considerable, I 
should rely on local depletion for a few days, or 
until these symptoms abated. This will soon 
happen and the patient be prepared for restorative 
treatment. In the irritable kind of abscess, local 
depletion should be less in quantity and frequency ; 
a very slight sedative course combined with a mild 
diet, and a careful alterative treatment, [not mer- 
curial,) by adding a small portion of the nitro 
muriate of gold, to the pill I have already men- 
tioned. 

The use of blisters, so frequently directed in 
Consumption, is always, in my opinion of doubtful 
utility; and in the constitution subject to this irri- 
table kind of inflammation, producing the irritable 
vomica, will tend more to increase than diminish 
the disease. I have known the cough aggravated, 
the appetite destroyed, the secretions all deranged, 
and the patient suffer much strangury, by the ap- 



TREATMENT OF CONSUMPTION. 65 

plication of blisters, and yet they were continued 
until the vital powers were sinking under their 
influence. 

Plasters of all kinds should be prohibited, when 
the individual is labouring under Consumption ; 
if applied about the chest they tend to impede 
respiration, by preventing full play of the ribs and 
sternum, and if used on other parts of the body 
they can have no other influence, but to increase 
the irritable state. 

Plasters of burgundy pitch were much used 
during the summer of 1832, as a preventive of 
cholera ; many wore these plasters who escaped 
the disease, and they attributed this good fortune 
to their use. Faith in plasters was unshaken until 
the disease broke out in the Arch street prison, and 
it was found that many died with the plasters on 
their stomachs. 

1 have always prohibited the use of plasters or 
the chest, and for this reason, that their composi- 
tion cannot possess virtues that shall counter- 
balance the great inconvenience the lungs suffer 
from a want of full inflation, which plasters worn 
over the ribs or breast invariably tend to prevent. 

The first and most important point in the treat- 
ment of Consumption, is to get rid of fever ; while 

6# 



66 TREATMENT OF CONSUMPTION. 

that state of the body exists called fever, we cannot 
expect the healing process to go on ; it will always 
be found, that ulcers on the surface and conse- 
quently open to inspection, will change from the 
healing process to the opposite during fever. In 
this way we can account for the suspension of 
discharge from the lungs of the consumptive pa- 
tient during the fever of hectic, and the free ex- 
pectoration, when the diaphoresis (the third stage 
of the paroxysm) is completely established. 

When we have completely removed hectic fever, 
we will find the remaining treatment easily man- 
aged, by the kind of depletion I have already 
hinted at, by free ventilation and a well regulated 
temperature, by proper clothing, allowing in all 
cases, deep and full inflation, by a kind of diet 
that shall nourish without stimulating, and by re- 
moving all the causes that may tend to produce 
irritability of disposition. 

When the bowels are obstinately constipated, 
they should be corrected by medicines that produce 
the effect, while at the same time they tend to 
alter that state of the blood which gives rise to the 
deposit of tuberculous matter. This has long been 
a desideratum devoutly to be wished ; perhaps it 
may be found in gymnastics and the use of my 



TREATMENT OF CONSUMPTION. 67 

prophylactic compound. I have always recom- 
mended the use of this compound for some weeks, 
after pneumonia or any of those diseases which 
might leave that state of the fluids, so frequently 
productive of obstruction and consequent tuber- 
cles, and in the majority of cases, I have had the 
gratification of seeing my patients return to per- 
fect health, leaving (of disease,) no trace behind. 
Whatever others may think of my remedies, I 
shall always praise the bridge that carries me safe 
over. 

The painful inflammatory ulcer often met with 
in Consumption, requires a treatment somewhat 
different from that demanded for the indolent 
ulcer; although the symptoms may appear the 
same, they will be found to differ widely, upon 
minute inspection. 

The patient can most frequently place his finger 
over that part of the lung in which this kind of 
ulcer exists ; the expectoration is generally viscid, 
scanty and dark. This species of ulcer or excava- 
tion, like the preceding, is produced by the sup- 
purating and bursting of tubercles, forming an 
open abscess, but unlike the preceding is con- 
tinually inflamed producing a cough almost con- 
stant, harrassing the patient day and night. 



68 TREATMENT OP CONSUMPTION. 

In the treatment of this form of diseased lung, 
we must be guided by the situation in which we 
find the venous system ; should we find much 
plethora generally existing, we must direct one, 
two, or three small bleedings from the arm, with 
moderate evacuations from the bowels daily, pro- 
duced by small doses of rochelle salts, with the 
continued use of the prophylactic mixture, for the 
purpose of arresting the new formation of tubercles 
in other portions of the parenchyma. After the 
venous system is relieved, Or if this should not 
require general depletion, we may remove the 
inflammatory disposition of the vomica, by the 
application of six, eight, or ten leeches to the spine, 
directly over the fifth dorsal vertebra, attending to 
the healthy action of the bowels daily, and the 
continued use of the prophylactic. 

When from the absence of pain and a change 
in the expectoration, we are led to believe the 
inflammatory condition is removed, we may com- 
mence the appproximation of the sides of the 
cavity, by careful inflation. The patient should 
now begin, by inhaling five minutes at each time, 
morning, noon, and evening, gradually increasing 
the time until he can use the tube half an hour at 
each period. This should be continued for three 



TREATMENT OP CONSUMPTION. 69 

or four days and then lessen the time, by revers- 
ing the process that was practised in the increase. 
As printed directions will be found accompanying 
each inhaling tube, it is deemed unnecessary to 
describe minutely the mode of using them, in this 
part of the work. 

I would here remark, that the instrument I have 
been in the habit of using for the last seven years, 
is in many respects different from the kind I now 
recommend, though the principle is the same. I 
used formerly a long tube with a calibre, a line and 
a half, and in some cases two lines in diameter; 
my patients were directed to breathe in and out 
through these tubes morning and evening, as long 
as they could, without feeling oppressed; in the 
majority of cases the result was remarkable. In 
all cases, the preparatory treatment I have just 
described, was premised. 

The first intimation of the utility of this mode 
of procedure occurred to me in 1824, while en- 
gaged in forming a bulbous extremity to a glass 
tube for the purpose of experiment; 1 was at the 
time indisposed from slight catarrh, from which I 
suffered some oppression. After blowing several 
bulbs which required full and deep inhalation, I 
found my lungs much relieved, the escape of air 



70 TREATMENT OF CONSUMPTION, 

was prevented by my mouth being closed upon the 
cool end of the glass tube, the air cells of my lungs 
were distended until portions of the tenacious 
mucus was loosened and expectorated, perhaps 
assisted by the stimulus imparted to the respiratory 
organs by this exercise of the lungs ; the relief was 
very remarkable, and I determined to substitute a 
glass tube of small calibre in the treatment of a 
case of Consumption, then under my care, for a 
mudge inhaler in use at that time. The improve- 
ment was soon evident, and I now determined 
upon the general use of such an instrument. 

I cannot recur to this circumstance, without a 
lively recollection of the advantages derived from 
the intimate and friendly intercourse I have long 
enjoyed with the Professor of chemistry in the 
University of Pennsylvania; in whose "laboratory 
the most obtuse mind, cannot long exist without 
receiving some useful impression, from the multi- 
plicity of apparatus, or the great brilliancy of ex- 
periments, seldom failing in the hands of a pro- 
fessor, saturated with chemical knowledge ; here 
we find the operations of the whole universe, con- 
densed to suit the limited vision of man ; to this 
great teacher of chemical science, I owe the origin 
of all my remedies for the cure of the lion of 



TREATMENT OF CONSUMPTION. 71 

diseases, Consumption. The blowing of glass 
bulbs, the compounding, and decomposing of 
chemical material, the effect of certain gasses upon 
the respiratory organs, are all the result of experi- 
ment here performed, and always encouraged by 
that great benefactor Professor Hare. 

That he may long enjoy the reputation he now 
possesses as a public lecturer and private citizen is 
the most ardent wish of one who cannot flatter. 

Strange to tell this practice prevented my 
being consulted in many cases of lung disease. 
When proposed by such of my friends as were 
acquainted with my practice, the reply was in 
many cases— he only uses glass tubes, pills, and 
mixtures; time has removed many prejudices that 
existed years ago, and I in common with many of 
my old class mates, have passed the period of 
probation, which every one engaged in the medi- 
cal profession must experience, and instead of not 
having patients to occupy my time, I may say now, 
I have too little time for my patients. 

Objections are always made to consultation 
with junior members in the profession, who fre- 
quently possess remedies the result of well tested 
experiment, which should always take the place of 



72 TREATMENT OP CONSUMPTION. 

useless compounds, the result only, of old establish- 
ed nosological rule, right or wrong. 

As soon as I find my patient prepared for the 
use of the tube, I direct a good generous diet ; and 
if great debility should exist, 1 add a small portion 
of wine, with daily exercise in the open air unless 
forbid by great weakness or the state of the 
weather. 

The chamber or sleeping room, should be large 
and the ceiling lofty ; no curtains should be used 
round the bed, and the fire, if any is required, 
should certainly be made of wood ; the bed clothes 
should be sufficient, but not heavy ; the bed should 
be a hair mattrass. \ 

In the treatment of the irritable ulcer sometimes 
met with in Consumption, one or two small leech- 
ings from the back will be found sufficient, or if any 
no great benefit can result from their repetition in 
this form of the disease ; one or two applications 
of eight or ten leeches will suffice to prepare the 
lungs for inflation ; but should oppression or cough- 
ing be produced, the tube must be omitted until 
this is removed by a few days use of the sedative 
emulsion, and the daily external application of the 
irritative liniment, or in mild cases the daily use of 



TREATMENT OF CONSUMPTION. 73 

strong salt water, beginning with it tepid, and di- 
minishing the temperature as the part shall become 
accustomed to its use. 

The fauces will generally be found inflamed ; if 
so, the part thus effected should be touched daily, 
or oftener if required, with a wash composed of 
nitro muriate of gold and rose water. This will 
soon be found to lessen or remove the inflamed 
state of the fauces, and in a few days the patient 
will be ready for inflation, without much inconve- 
nience. In this form of disease, I would particu- 
larly recommend the removal of all unnecessary 
clothing about the neck or shoulders, and by 
cautious steps to accustom this part to all the 
changes of our climate. This can be done by 
daily diminishing the amount of clothing, until as 
little is worn as the neck can be kept comfortable 
with, and by using for a long time, night and 
morning, friction with a coarse towel, saturated 
with strong coarse salt water. 

The clothing of the body should be sufficient, 
but not too heavy ; the chest should never be con- 
fined in any way by the garments ; the lower limbs, 
and particularly the ankles and feet should never 
be allowed to feel cold. 

When we succeed in establishing a healthy 

7 



74 TREATMENT OF CONSUMPTION. 

action of the surface of the body, we will soon 
find the same communicated to the lining mem- 
brane of the throat and lungs ; and yet we find 
many physicians using large plasters or prescribing 
them for their patients, with adhesive additions, to 
be worn on the chest, oppressing respiration, and 
debilitating the skin. These are worse than use- 
less, unless they are small and composed of material 
that may be absorbed constituting an endermic 
treatment, and having some decided beneficial 
effect on the existing disease. I have sometimes 
used iodine in this way for some of the glandular 
diseases with great effect. 

This brings me to the consideration of bron- 
chitis and its treatment. 

By the term bronchitis, we are to understand an 
inflammation of the lining membrane of the bron- 
chial tubes ; but we frequently find the individual 
said to have bronchitis, complaining only of the 
trachea or larynx, which should be called laryn- 
gitis when it occupies the part of the throat at the 
root of the tongue. Trachitis when the inflam- 
mation exists between this part and the top of the 
breast bone, and bronchitis when confined to that 
portion of the wind tube, which branches at about 
this point, or immediately opposite the third dorsal 



TREATMENT OF CONSUMPTION. 75 

vertebra, and ramifies very minutely through the 
whole substance of the lungs. This tube through 
its whole extent, is kept distended by cartilaginous 
rings ; indeed it appears to be entirely formed by 
a series of these rings, joined together by liga- 
ments. Nosology can be of little importance, 
particularly in diseases of this tube ; it can be of 
little moment to the practitioner or his patient to 
discover the particular locality of an inflammation 
known by them to exist only in one organ. Disease 
generally commences at a small point, and spreads 
frequently throughout the whole extent of an 
organ, altering in no manner its character, although 
increased in degree ; the treatment being the same 
with a corresponding increase in potency, will 
always be found producing the same benefit. I 
have repeatedly cured, what was called bronchitis, 
by the application of a small portion of a weak 
solution of the nitro muriate of gold to the fauces, 
and strong salt water to the neck daily ; and again 
I have found cases requiring repeated bleeding or 
leeching, dieting, housing, and the artificial pro- 
duction of urticaria. Yet this was the same dis- 
ease, though in not the same degree. 

This inflammation of the windpipe or its 
branches is sometimes neglected until small ab- 



76 TREATMENT OF CONSUMPTION. 

scesses are produced on its surface, these burst 
forming open ulcers, and sometimes the ulceration 
penetrates to the cartilaginous rings; when this 
happens it must be obvious that the case will be 
chronic, and require a treatment of the most per- 
severing kind, this cartilaginous inflammation 
should be looked upon as of the same nature as 
inflamed cartilage in the other parts of the body. 
We should avoid exposure to a damp or very cold 
atmosphere, and if compelled to leave our dwelling 
from the nature of our business, the cold or damp 
air should be prevented from having direct contact 
with the inflamed bronchia, by holding a handker- 
chief loosely over the mouth and nose. Apart- 
ments heated by furnaces should be carefully 
avoided by individuals affected with any form of 
bronchitis. 

The best constitutional treatment in this chronic 
form of bronchitis, will be such as. has been found 
useful, when inflammation of cartilages existing 
in other parts of the body demand attention, with 
the exception of all debilitating remedies. 

The inhalation of resinous fumes, the applica- 
tion of moxa to the upper part of the chest and 
sternum, the internal use of sarsaparilla, and the 
alterative prophylactic pill. Attention should also 



TREATMENT OP CONSUMPTION. 77 

be particularly paid to the dress in this form of 
disease, the feet should never be cold or damp, and 
any undue moisture should not be excited by too 
much clothing about the neck or chest; an over 
coat should never be worn in the house, as fre- 
quently happens to professional men, making short 
calls ; nor should the individual ever sit with his 
back to the fire ; these rules may be considered of 
little importance, but experience will prove their 
utility. 

Gestation frequently arrests Consumption, and 
if the treatment was always properly attended to 
after parturition, the physician could in the ma- 
jority of cases carry out this prophylactic of nature, 
and restore to health, the individual whose good 
fortune it has been, to be so blest. 

We frequently find Consumption arrested during 
gestation ; and in our post mortem examinations 
we see in the lungs of females who die of Con- 
sumption, after having many children, large cica- 
trices extending several inches in many cases, in a 
direction crossing the thorax, which proves the 
previous existence of abscess ; and from the ex- 
pectoration and cough diminishing as gestation 
goes on, it is but reasonable to conclude, that the 

>7* 



78 TREATMENT OF CONSUMPTION. 

pressure of the gravid uterus produced this gradual 
approximation and consequent reunion. 

Now it has always appeared to me a matter of 
great importance, for ladies under such circum- 
stances, to select an accoucheur whose time was not 
so entirely taken up in his profession, that he is 
compelled to neglect the after treatment of his pa- 
tient; health more frequently depends on this than 
the public are generally aware of; if the abdominal 
compress or bandage used after delivery, be not 
properly managed, the consumptive individual 
soon feels her old symptoms returning ; and per- 
haps in a very few days will find her strength 
rapidly declining, her cough renewed, her^expecto- 
ration, her night sweats, her hectic flush, resuming 
their former unwelcome regularity. Perhaps under 
these circumstances, she will be directed to nurse 
her infant, and an extra drain is thus added, has- 
tening her destruction, while her infant and her 
cough makes sleep a stranger to her eyelids, 
and the new being is poisoned by what it feeds 
on. 

Can this be prevented ? Certainly. Nature 
points out the way, her works are simple. 
The married female is for the most part more 



TREATMENT OF CONSUMPTION. 79 

exempt from Consumption. And if this should 
take place, her hope of cure should be greater than 
in single life. The common functions are for the 
most part more regularly performed, and if she 
should become a mother, (being threatened with 
Consumption,) the certainty of cure is increased. 
After parturition the bandage should be broad and 
made to fit the person perfectly ; it should be ap- 
plied by her physician, and examined daily ; it 
should cover the abdomen completely, and be so 
constructed, that there shall be no slipping up ; we 
should endeavour to bring the stomach and bowels 
as firmly in contact with the under surface of the 
liver and diaphragm, as they were before delivery; 
thus continuing the support the lungs may have 
had from the uterus. We should also dry up the 
milk as soon as possible, and keep the chamber 
cool and airy, not without fire, but this should de- 
cidedly be of wood in an open chimney ; a hori- 
zontal posture should be enjoined and a generous 
diet allowed. The child should be nursed by a 
healthy female, and the use of prophylactics and 
inhaling at once commenced. As soon as practi- 
cable after the third week, she should ride out 
daily, with prudence in her dress. By this care 



80 TREATMENT OF CONSUMPTION. 

the mother will frequently escape debility and its 
consequence, and the infant become robust, which 
could not have happened without this mode of 
practice. 



CASES OF CONSUMPTION. 



CASE I. 



J. B. S , aged forty two years, applied to 

me in December, 1833, for the relief of a severe 
neuralgic pain of the heart, attended with much 
palpitation, and constant cough. He stated that 
he had been directed by his physician to observe 
perfect rest, to eat no animal food, and to take of 
lugal solution five drops night and morning. 

His symptoms (for which he supposed he was 
using the best remedy,) increased, and he became 
alarmed for his own safety; after persevering for 
several months without relief I was consulted. 

I found upon examination of the chest, that the 
summit of the left lung was the seat of an abscess, 
occasioned no doubt by a severe inflammation of 



82 CASES OF CONSUMPTION. 

that part which he stated had existed a few weeks 
before the palpitation of the heart commenced. 

I assured him at once that the heart was free 
from disease, although its motion was somewhat 
out of order, and commenced a different treat- 
ment. 

I directed one of my prophylactic pills to be 
taken nightly, and the application often leeches to 
the spine immediately over the fifth dorsal verte- 
bra, and a ride of half a mile in an open carriage 
in the morning of every fine day ; on the fourth 
day of this treatment, my patient called at my 
office some little improved in spirits, with rather 
less frequency of pulse. The expectoration was 
still very great, but the cough less frequent ; the 
pills had improved the state of his digestion, and 
the uneasy feeling he had complained of for many 
months, was in a great measure removed. I di- 
rected the left side of the thorax to be bathed 
night and morning with the irritative liniment, and 
the pills to be continued. On the twelfth day of 
my treatment he called again to say the soreness 
had all left him ; upon applying my ear over the 
upper portion of the left lung, I found distinct pec- 
toriloquism; I now furnished him with a small 
glass tube, directing him to breathe through it as 



CASES OP CONSUMPTION. S3 

long as he could at one period, without being 
oppressed, to continue the pills and liniment, and 
to call in a few days again. 

On the following day he left the city, and re- 
mained at his brother's residence, in Delaware, for 
two months ; at the expiration of this time he 
returned, when the change for the better, prevented 
my immediately recognising my patient. 

He stated that the cough had left him gradually, 
his expectoration was gone, and that he was now 
able to leave for the west — which had been his 
determination a year previous, had not his heart 
affection prevented it. (Still harping on the old 
palpitation.) Two years after I received a letter 

from J. B. S , informing me his health was 

never better, and that he had married and trans- 
ferred his heart affection. 



CASE II. 

A young lady, the daughter of a very respecta- 
ble grocer in this city, who had for many months 
suffered from weak digestion, and consequent 
debility, for which she had taken various remedies 



84 CASES OF CONSUMPTION. 

without permanent benefit, became consumptive ; 
after many proofs from various symptoms, of the 
existence of phthisis, I was called to visit her in 
consultation with her uncle, her attending physi- 
cian, who gave it as his opinion that she could not 
survive six weeks ; and observed that I had been 
called to satisfy her brother. I replied, as I was 
then in the house, perhaps he was already satisfied, 
and that I conceived the next step of importance, 
was to examine the case. I found the patient 
much emaciated, with some cough and night 
sweats. And upon applying my ear to the chest, 
discovered the existence of a small cavity at the 
summit of the right lung, while I also detected a 
dry crepitous rattle, with bubbles manifested by 
auscultation, the certain proof of emphysema. 
This state arose from a spasmodic affection of the 
throat, which the patient had been subject to for 
more than a year. There existed much oppres- 
sion and upon being informed that this symptom 
had come on suddenly after a distinct sound in the 
chest, resembling the tearing of parchment, I con- 
cluded in my own mind, that a rupture of some of 
the air cells had taken place, and that in time cica- 
trization would happen through the consequent 
dilitation of the parenchyma. I, therefore, sup- 



CASES OF CONSUMPTION. 85 

posed a favorable prognostic existed, and of course 
differed in opinion from the attending physician. 
I supplied this patient with a large quantity of 
prophylactic pills, one of which I directed to be 
taken morning, noon, and night; from the exist- 
ence of spasms in the throat, preventing free respi- 
ration, 1 concluded there was little use for an 
inhaling tube. And I am happy to add, that this 
young lady now enjoys perfect health. 



CASE III. 

Mrs. M. W , aged forty two years, applied 

to me in 1834, in consequence of a continued 
hacking cough, which had been existing for four 
months, notwithstanding the use of all the known 
remedies, or cough mixtures : upon examination 
of the chest by percussion, I at once discovered 
the right lung was perfectly useless to her, and that 
its greater portion was occupied by an abscess. 
Believing surgery might afford some relief, 1 pro- 
posed a consultation with my friend Dr. J. Ran- 
dolph, which was acceded to ; the doctor made the 
same examination, and agreed with me at once in 

8 



86 CASES OF CONSUMPTION. 

opinion. The patient was very desirous that some- 
thing should be done to relieve her breathing, and 
was willing and anxious to have an operation 
performed ; there being great emaciation and very- 
great debility, we concluded to support her 
strength with a portion of rich soup and malt 
liquor daily ; this she took freely for three or four 
weeks, and recovered some strength, the bowels 
keeping tolerably regular for some time ; this did 
not continue long, however, and at the expiration 
of about four weeks from our first visit, obstinate 
constipation took place, and all purgative medi- 
cine swallowed produced no operation. The use 
of a teribinthinate injection had a better effect. A 
large tumor was now distinctly felt immediately 
under the right false ribs, and in a few days this 
became very prominent, yielding fluctuation by 
percussion. She now repeated to me her desire 
for an operation, and begged me to puncture this 
large gathering, (as she called it.) I promised this 
should be done, and on the following day, request- 
ed my friend Dr. G. S. Morton to be present at the 
operation. 

Dr. Morton examined the tumor and we jointly 
concluded, that an operation was not only safe, 
but justifiable. 



CASES OF CONSUMPTION. 87 

After providing bandages, compresses, etc., I 
proceeded by making a small incision through the 
skin immediately over the most prominent point 
of the tumor, and then changing my scalpel for a 
small trocar, I gently pressed this instrument 
through the muscles and into the enlarged liver, 
the seat of the abscess ; upon withdrawing the 
trocar and leaving the canula, (with which this 
instrument is generally sheathed,) thin unhealthy 
pus flowed freely through it. This continued until 
six quarts had been discharged without any signs 
of syncope being produced. I should not mention 
this large quantity, had not Dr. Morton been pre- 
sent who can vouch for the authenticity. 

The respiration and general unfavorable symp- 
toms continued to improve, the cough completely 
leaving her for three weeks. At the expiration 
of this time, the oppression and cough returned, 
and she sunk rapidly, living one month after the 
operation, from which no ultimate benefit could be 
promised, although demanded for relief. 

Autopsy, assisted by my friend Dr. Morton, 
twelve hours after death: the right lung as had 
been anticipated, was nearly destroyed by ulcera- 
tion, except a small portion which was found 
shrunk up under the right clavicle, while the cavity 



-;■ 



88 CASES OF CONSUMPTION. 

of the pleura of the right side was filled with the 
same kind of matter which had been discharged 
by the operation a month previous. The heart 
was found to be perfectly natural, although this 
patient had suffered much from palpitation ; the 
left lung appeared healthy with the excep- 
tion of its upper lobe which was hepatized, the 
cavity of the pleura of this side contained about 
four ounces of serum. The right lobe of the liver 
was found greatly distended, and upon being 
punctured, discharged as much thin matter or pus 
as would make up, (with the quantity found in the 
chest,) the same amount discharged at the time of 
the operation; the liver was only a sack contain- 
ing this fluid, its walls not thicker than four lines, 
its upper portion adhering to the diaphragm and 
opening into the right pleural sack, by a sinus ; 
accounting for the great relief the patient had ex- 
perienced in her breathing after the operation. 

The health of this patient had been declining 
for many years from leucorrhea ; this circumstance 
led me to examine particularly the state of the 
uterus; and from the situation in which I found 
this organ, I concluded our general remedies for 
that disease must frequently be very inefficient ; I 
determined from this hint to change the practice 



CASES OF CONSUMPTION. S9 

somewhat, and my success in the treatment of 
uterine diseases since that period will always pre- 
vent my regretting a desertion from the old plan 
of treatment generally pursued. 



CASE IV. 

Proving the injurious effect of inflammation 
and vesication about the chest, by blisters or 
plasters. 

Miss E. S , aged 17 years, in the spring of 

1835, after long exposure to a cold and damp 
easterly wind by riding in an open carriage, was 
taken with a chill which proved to be the com- 
mencement of pneumonia. Medical aid was soon 
called and a proper treatment at once directed ; 
she was bleed freely, and as often repeated as the 
nature of the case required. Evacuants were used 
freely and properly, and a speedy convalescence 
was brought about. 

Some days after her physician left her, she com- 
plained of a slight pain in the right side, for the 
relief of which her parent administered a large 

8* 



90 CASES OP CONSUMPTION. 

dose of calomel, which operated slightly, and was 
not followed by any other medicine ; the following 
day, she had some fever and a return of her cough ; 
the breast was rubbed with a stimulating liniment, 
and a blister applied. The consequent inflamma- 
tion of the cuticle and general soreness produced, 
prevented full motion of the chest, and the patient 
soon complained of much oppression in breathing. 
This created some alarm, and her physician was 
again called in, who imbibing some of the 
views of the patient, directed a large plaster of 
burgundy pitch, sprinkled with Spanish flies, to be 
applied to the back and shoulders. This effectually 
prevented all healthy respiration or full inflation, 
and the best selected internal treatment was conse- 
quently of no avail ; the lungs were supposed to be 
diseased, and I was called in consultation. I could 
not explore the chest on my first visit, in conse- 
quence of the very great inflammation and sore- 
ness of the whole surface of this part occasioned 
by the blisters, liniments, plasters, &c, &c. But 
finding the bowels still slow, with a slight degree 
of ptyalism, I directed one of my pills to be given 
morning, noon, and night, (the composition of 
which I made known to the attending physician,) 
with ten grains of nitrate of potash as often, ah 



CASES OF CONSUMPTION. 91 

the plasters to be removed, and the chest bathed 
frequently with a little cool brandy. The applica- 
tion of brandy to surfaces inflamed in this way, 
or by blisters alone, is perhaps one of the most 
soothing and comforting we can direct. 

The nitre, the prophylactic pill, the removal of 
all external irritants, had a most charming effect. 
On my next visit, the lively countenance, the 
cheerful expression, the desire to be questioned, 
that she might answer for herself, told all that I 
could wish to hear. 

Her fever had left her, the skin felt naturally 
moist, the tongue looking much more like health, 
the eye lively, and the irritable state of the throat 
much subdued. The peristaltic action of the 
bowels improved, and so much improvement in 
the state of the skin over the thorax, that I was 
now able to examine the state of the lungs by per- 
cussion, auscultation, &c. 

I found immediately under the left clavicle, the 
respiratory murmur could not be heard ; this part 
gave a dull sound on percussion, and the difficulty 
of breathing was much increased by laying upon 
the left side. As there was some pain produced 
by a deep inspiration in this part, I directed ten 
leeches to be applied to the back in a small com- 



92 CASES OF CONSUMPTION. 

pass over the fifth dorsal vertebra, and the pills to 
be continued. On my next visit I found very 
little uneasiness or pain in any part of the chest, 
by full inflation, and less inconvenience produced 
by change of position. I now furnished a small 
glass tube for inhaling, with the general directions 
in manuscript, ordering at the same time a con- 
tinuation of the pills morning and evening, and a 
moderate diet of small portions of venison, (one 
ounce,) and one cracker, morning, noon, and night, 
with one wineglass of good ale after the mid-day 
meal ; the daily use of dumb bells, and a brisk 
walk up and down the chamber several times 
through the day. With these directions and a 
promise on her part to continue them faithfully, 1 
left my patient under the care of her attending phy- 
sician. 

At the expiration of six weeks, she called at my 
house in a carriage to report her health; there 
was now distinct respiratory murmur heard in 
every part of the chest, and I agreed with her in 
opinion, that further treatment was unnecessary. 

This young lady still continues to enjoy unin- 
terrupted health, without the least appearance of 
ever having had lung affection. 



CASES OF CONSUMPTION. 93 



CASE V. 

Case of recovery after the formation of tubercles, 
in a constitution of a hereditary predisposi- 
tion. 

In March, 1835, I was consulted by Miss M. 

R , aged twenty two, for a painful affection of 

the chest, attended with considerable cough and 
expectoration of blood, mixed with frothing yellow 
matter. She stated that she had lost her mother 
and sister with the same disease, and believed she 
herself was going rapidly ; upon exploring the 
chest I found the summit of each lung was ob- 
structed by tubercles, several existed on the sides 
of the neck, and many under the scalp ; she expe- 
rienced much inconvenience from these small 
tumours, when her bonnet pressed them ; I pro- 
posed their removal which she acceded to, and 
commenced a general treatment : I directed her to 
leave the city, to use daily a pair of heavy dumb- 
bells, to make full inspirations frequently through 
the day, to swing by the hands from the lower 



94 CASES OF CONSUMPTION. 

limbs of peach or apple trees, (which I knew she 
would find on the farm she had chosen for her 
location.) I provided her with an alterative mix- 
ture and a large box of prophylactic pills, she con- 
tinued at the farm, and most of the day, (in fine 
weather,) in the orchard swinging upon some of 
the horizontal limbs. The expectoration grad- 
ually diminished, her strength returned, her chest 
and hips expanded, she became robust, and still 
enjoys good health; her chest in August, 1841, 
when I last examined it, showed no marks of dis- 
ease. I then for the first time since I had made 
it, observed that I had kept my promise, and that 
with common prudence she might enjoy a long 
life. 

I had left one of the small tumors on the head, 
for the purpose of seeing whether the internal use 
of medicine could produce its absorption ; upon 
searching for it after she returned to the city, I 
could discover no trace of this tubercle. 

Note. — This case was to be the third victim in one family, see 
introduction, page 19. 



GASES OF CONSUMPTION. 95 






CASE VI. 

Consumption in its very advanced stage cured 
by the supervention of another disease. 

Mrs. S. W , aged thirty nine, applied to me 

in May, 1835, for advice in her case. She stated 
that for eighteen months previous, her health had 
been declining, with continued cough, much ex- 
pectoration of bloody matter, and hectic fever. 
She had been for six months under the care of 
two very able physicians, whose treatment cor- 
responded with that of others under the same cir- 
cumstances : as she had received no benefit from 
medicine, and as dropsy had taken place, which in 
her opinion, was to end her suffering, she gave up 
ail hopes of recovery ; but as her cough and ex- 
pectoration had diminished, while her strength had 
increased, and her chills, fever, and night sweats 
had completely left her, she consulted me for the 
cure of her dropsy. This I observed might be ac- 
complished, but, that in my opinion she owed her 
recovery from cough to this disease. This opinion 



96 OASES OP CONSUMPTION. 

I formed from the fact of there being no edema, 
which led me to conclude the dropsy was encysted, 
while the abdomen was as large as is generally 
met with in the last months of gestation. I had 
no doubt that the relief from her pectoral affection 
was owing entirely to the support the diaphragm 
and lungs received from the existence of this dis- 
ease. 

I, therefore, advised her to continue without 
medicine, and to let me know immediately, if any 
of her old symptoms of cough or expectoration 
should take place. In October, 1835, 1 was again 
called to visit this patient, when she requested that 
I would do something for her dropsy, as she had 
no return of cough or spitting, and thought that 
dropsy had done all it could for her, and that now 
she would like to do without it if possible. Having 
some suspicion of large hydatids in the uterus, I 
proposed an examination per vaginum, and soon 
discovered that the views I had of her case were 
well founded. The uterus was as large as we 
generally meet with at the ninth month of gesta- 
tion ; I proposed the introduction of a common 
sound, through the os uteri, which was acceded to, 
and by making a few rotatory movements, broke 
the sack containing the fluid, and in a few mo- 



CASES OF CONSUMPTION. 97 

ments my patient was relieved from ail her distress 
from dropsy. I directed her to lie with her head 
and shoulders low, and to keep constantly applied 
round the lower part of the abdomen, a broad 
bandage moderately tight ; my object was to sup- 
port the diaphragm as much as possible. She soon 
recovered without the use of any medicine, and 
now continues in perfect health. 



CASE VII. 

A. W , aged thirty two, consulted me in 

November, 1836, for the relief of a troublesome 
cough, with scanty expectoration of matter streak- 
ed with blood, which had existed for several 
months. He had been frequently leeched on the 
throat, and as often blistered. He had also inhaled 
iodine for a long time by the advice of his physi- 
cian, and had tried a short sea voyage without 
relief. Upon exploring the chest, I found the 
parenchyma healthy throughout. He complained 
when exposed to the atmosphere of heated rooms, 
of a deep seated pain and sore feeling at the upper 
part of the sternum, (or breast bone,) which was 

9 



9S CASES OF CONSUMPTION. 

much increased by inhaling a very cold air, but 
was greatly lessened when the weather was tem- 
perate. He had avoided all stimulating drinks, 
and animal food, dressed warm, and particularly 
protected the chest and neck. This 1 directed he 
should remove as soon as possible, and bathe the 
part night and morning with cold salt water, I 
supplied him with my solution of gold, and ordered 
him to touch the fauces with a soft camel's hair 
pencil, moistened with this solution night and 
morning. To commence the daily use of the Lisbon 
diet drink, and one of the compound prophylac- 
tic pills to be taken nightly. At the expiration of 

one week A. W called at my office much 

improved, his expectoration had diminished very 
considerably, his soreness of throat nearly gone. 
He continued to mend from this time, and after 
this treatment lasted two months he considered 
remedies unnecessary. This patient continues to 
enjoy perfect health. 



CASES OF CONSUMPTION. 99 



CASE VIII. 

Case of incipient tubercular consumption cured, 

Miss E. D , aged twenty four, canre from 

the state of Maryland to consult me, in the month 
of September, 1S40, she complained of great sore- 
ness of the throat with enlarged tonsils, and con- 
tinued cough, except a few hours after the use of 
a cough mixture, which always produced sleep. 

The upper lobe of the right lung yielded a dull 
sound upon percussion, and she complained of a 
deep seated soreness when pressure was made on 
the ribs over this part. Her cough was very con- 
stant, but without expectoration ; her pulse fre- 
quent and tense, the tongue coated except near the 
end. which was of a deep red, her cheeks occupied 
by a hectic blush, lips thick and protruding. In 
fact all the marks of incipient tubercular consump- 
tion, commencing in a constitution loaded with 
scrofula. ( The indications in this case were plain ; 
to soften and cause absorption of the tubercles, to 
remove the hectic, and change the diseased action 



100 CASES OF CONSUMPTION. 

into healthy. Laennec it would appear by refer- 
ence to his work on diseases of the chest, places 
little confidence in remedies said to possess the 
power of softening tubercles ; I am by no means 
astonished at this. By a perusal of his writings, 
it will clearly be seen that this " great author," 
like many of his predecessors, introduces to the 
reader a variety of remedies, the utility of which 
in his mind is doubtful ; without attempting to ac- 
count for their failure, or proposing a better means 
of cure. 

He classes under the head of empirical reme- 
dies, mercurial salivation, emetics, (which have 
been highly recommended by many distinguished 
practitioners in imitation of a sea voyage ;) why 
they should select the most unpleasant part of a 
sea-voyage, has I must acknowledge, always ap- 
peared strange to me : and from what I have 
already said in relation to the advantages of a sea- 
voyage, it must appear evident that I place little 
reliance on the mere effect produced on the 
stomach. Laennec also places under the head of 
empirical means, charcoal, mushrooms, red cab- 
bage, wolf's bane, crabs, oysters, frogs, vipers, 
electricity, opium, cicuta, cinchona, hydrocyanic 
acid, the seeds of the phellandrium, aquaticum, 



CASES OF CONSUMPTION. 101 

&c, &c. How the opinions of Laennec have 
been received by those practitioners who have 
relied on opium, cicuta, hydrocyanic acid, mer- 
cury, &c, I know not. — But to return to my 
subject ; I directed this patient to use all the out 
door exercise practicable, to throw off corsets and 
all restrictions to a free motion of the muscles of 
the body or limbs, to have a double ladder erected 
in the chamber, and a single large sized rope sus- 
pended from the top round ; on this ladder she was 
to perform all the evolutions and calisthenics in 
her power, to climb the rope to the top by the use 
of the hands and arms alone, to use dumb-bells 
twenty minutes night and morning, and ride or 
walk out whenever the weather would permit ; 
1 directed as medicine the daily use of my prophy- 
lactic compounds, and every evening ten grains of 
the nitrate of potash. 

To rub the upper portion of the right side of 
the chest with an ointment of iodine nightly, and 
use the inhaling tube every four hours, for twenty 
five minutes at each time. I prohibited all animal 
food, except wild meats, and these were to be used 
but once in twenty four hours. With a continua- 
tion of these directions, I visited my patient every 
three or four days, perceiving improvement at 



102 CASES OF CONSUMPTION. 

every visit. Much change in the skin, and whole 
expression, was soon remarked by all her friends ; 
the thickness of the lips began to diminish, the 
hectic left the cheek, the tongue lost its morning 
dryness, the stoop and disposition to approximate 
the shoulders was soon changed to an erect and 
broad expansion of the chest, and at the expiration 
of four months she left the city in good health. I 
frequently see the relatives of this patient, and 
learn from them the pleasing fact that she still en- 
joys most excellent health. 



CASE IX. 

Case of inflamed ulcer in the lungs cured by 
leeching, prophylactic pills, and inhaling. 

S. M , aged thirty three, called on me in 

February, 1837, with bloody expectoration, mid- 
day chills, evening fever, and nocturnal perspira- 
tion ; much emaciated, considerable cough, and 
great loss of strength, most sensibly felt early in 
the day from the constant perspiration of the 
night. I directed fifteen leeches to be applied over 



CASES OF CONSUMPTION. 103 

the fifth dorsal vertebra, and a pill to be taken 
nightly, composed of teraxicum cicutae and nitro 
muriate of gold. At the end of one week he called 
at my office free from pain or soreness in any part 
of the chest, and upon exploration with the stetho- 
scope, I could distinctly perceive the existence of 
a cavity near the summit of the right lung with 
clear pectoriloquism ; the corresponding portion 
of the left lung yielded a dull sound by percussion, 
while the respiratory murmur was very dull and 
indistinct. The night sweats still continuing, with- 
out perceptible chill, or much fever preceding. 
Having frequently met with cases that v/ere re- 
lieved of this unpleasant symptom by a remedy 
often used in the practice of my late and highly 
esteemed friend Dr. Joseph Parish, whose medical 
career was noted for success, I determined upon 
its trial in this case. I therefore directed the 
whole surface to be sponged every night with 
a strong solution of alum in hot water, to which 
had been added a small portion of brandy ; or- 
dering at the same time the regular use of my 
prophylactic pills, and a full inflation of the lungs 
through the inhaling tube, which I had provided 
for this patient, made of glass two feet in length, 
having a calibre one and a half lines in diameter. 



104 CASES OF CONSUMPTION. 

The soreness originally complained of never re- 
turned sufficiently to demand a second leeching— 
the expectoration diminished gradually, the bath- 
ing or sponging was used for two weeks, when 
the night sweats had completely subsided. The 
prophylactic pills were used for three months, and 
the inhalation continued at intervals for two ; at 
the expiration of this time the lungs became 
voluminous, the pectoriloquism was no longer 
heard at the summit of the right lung, while 
in the left the respiratory murmur was now 
distinct : October, 1841, continues to enjoy good 
health. 

Flattered by my success, I determined to test my 
genius, if any I possessed, to the construction of 
better inhaling tubes ; these I subsequently con- 
trived of various material ; of gum elastic stomach 
tubes, of large catheters, of lead, and of wood. They 
answered my purpose tolerably well, until a friend 
of mine returned from a visit to Europe, who 
supplied me with breathing tubes from the maker 
employed by the celebrated Dr. Ramadge. In 
many respects these tubes are superior to any I 
have ever used, and I have had a large supply 
constructed by a mechanic in this city for general 
use. There is one great advantage in having a 



CASES OP CONSUMPTION. 105 

maker at hand, the length of tubes may be in- 
creased or diminished, while the calibre can be 
made to suit the peculiar state of the lungs, or age 
of the patient ; much attention to this point is 
required when tubes are used. 



CASE X. 

In February, 1839, I was called to visit the 
daughter of a respectable merchant of New York, 
whose health had been declining for more than 
eighteen months ; she complained of constant pain 
about the middle lobe of the right lung, with pal- 
pitation of the heart, and much oppression in 
breathing : she had been confined to the house for 
more than six months, by the advice of her former 
physician, but not to her bed. She had taken 
many mixtures for her cough, which was very 
troublesome, but without relief. She complained 
of some soreness upon pressure being applied to 
the fifth, sixth, and seventh dorsal vertebrae : this 
led her parents to believe the cough and emacia- 
tion was occasioned by a disease of her spine, for 
which I was consulted. Upon examination of the 



106 CASES OF CONSUMPTION. 

spine I could not percieve any derangement in its 
column, but had no doubt that the state of the 
lungs communicated through the nervous system, 
their increased sensibility to this part. The locality 
of pain is deceptive, and often will mislead a 
superficial observer ; we have often seen cases of 
severe hemiplegia, treated with blisters, setons, 
emetics, narcotics, &c, without relief, at once 
cured by the extraction of a decayed tooth, which 
had not attracted the attention of the patient or 
perhaps occasioned the least uneasiness. Upon 
exploring the chest, the cause of this soreness of 
the spine was soon discovered; there existed about 
the middle of the right lung a space of about six 
inches in circumference occupied by tubercles, a 
circumstance sufficient in my opinion, to account 
for the derangement of the motion of the heart, 
as well as the existence of all the other unfavorable 
symptoms. There were several small moveable 
tumors in the direction of the absorbents on the 
right side of the neck, which the patient stated, 
had existed for more than twelve months ; the skin 
was always dry and the temperature above the 
natural standard of health. 

I commenced the treatment, by causing all the 
articles of dress (corsets, tight frock bodies, &c.,) 



CASES OF CONSUMPTION. 107 

to be removed, and to use no garment that could 
in the least impede a full inflation of the chest, or 
prevent the arms from being raised perpendicularly 
above the head ; I had fifteen large leeches ap- 
plied to the portion of the spine complained of, and 
directed one of the prophylactic pills to be taken 
morning, noon, and night ; to rid the system more 
perfectly of all the scrofulous tendency, I directed 
at the same time twenty drops of my solution of 
bromine every four hours, and a bath daily of salt 
water at a temperature of eighty degrees Fahren- 
heit. This treatment was continued for one week 
with decided improvement, and at the expiration 
of that time, finding less cough and pain in the 
chest, I added to the remedies the use of the in- 
haling tube, a double ladder, dumb-bells, &c. 

In about six weeks from the commencement of 
the treatment, the small tumor on the neck sub- 
sided, the pain left the breast and back completely, 
the respiratory murmur was distinctly heard 
throughout the chest, and the patient now took 
daily exercise on horseback. She continued under 
my care for three months longer, when she return- 
ed to her native city in perfect health, I frequently 
hear from this patient who continues to be active 
and well. 



108 



NOTE. 

I might go on with my history and treatment of 
cases, but my time is too much occupied at pre- 
sent in practice, to allow sufficient leisure to put 
them in form for publication. I shall therefore 
keep the manuscript account of each case of Con- 
sumption always in my note book, which will be 
found upon my office table, with the name and 
residence of most of my patients. 

I shall now pass on to the consideration of some 
of the most important derangements of the vital 
functions. 



DISEASES OF THE HEART. 



The healthy action of this organ is frequently 
disturbed by other diseases, while its deranged 
motion constitutes only one of their symptoms ; 
the practitioner being misled often prescribes 
remedies under these circumstances that can have 
no influence on the real seat of disease ; this is 
consequently allowed to go on unmolested, and 
the palpitation or irregular action of the heart 
which was originally symptomatic, becomes idio- 
pathic, and consequently in most cases unman- 
ageable. Diseases of the lungs, liver, stomach, 
bowels, spine, and nervous system, may be classed 
among the causes of heart affections; while the 
passions, such as love, grief, envy, and despair, 
should not be overlooked. 

Idiopathic affections of the heart, are in my 
opinion of rare occurrence, comparatively speak- 

10 



110 DISEASES OF THE HEART. 

ing; they are generally unmanageable, and the 
individual thus afflicted, drags out a miserable life. 
Post-mortem examinations frequently betray the 
existence of diseases of other organs with decided 
marks of having preceded the heart affection. 
Any obstruction in glands, will often produce 
derangement of the circulation, and consequently, 
great alteration in the heart's action ; these glan- 
dular diseases frequently owe their origin to some 
derangement in the respiratory apparatus, by 
which the blood not being perfectly changed from 
venous to arterial, is unfit for the purposes of 
health ; in this state it is returned to the heart, and 
sent by the route of the circulation to supply the 
different glands of the body. Its unfitness for this 
purpose soon produces glandular disease, and 
congestion of the venous system becomes the result. 
Derangement of the organs of digestion soon fol- 
lows, debility with all its consequences takes place, 
and the heart is condemned unheard, or like the 
innocent victim of justice, not listened to by those 
who nominally preside as judges. The physician 
may feel the pulse and perhaps look at the tongue, 
but ridicules the use of the stethoscope, and con- 
sequently is ignorant of the state of things exist- 
ing at the fountain of life. 



DISEASES OF THE HEART. Ill 

< 

We frequently find congestion in the venous 
system producing derangement of the digestive 
organs, which not being relieved by medicine 
alone, soon yields to its use when assisted by free 
depletion. 

Those physicians, who are accustomed to think 
for themselves, and to apply to nature as the great 
and only unerring teacher, are aware of the fre- 
quency of such congestions, and their cause. The 
injected state of the capillary vessels of the stomach, 
and intestines, must be productive of important 
derangements of the action of these organs. It is 
essential, therefore, to restore them to healthy ac- 
tivity by general or local bleeding ; and shonld 
this not suffice to bring them back to their natural 
functions, tonics may then be administered to cor- 
rect any debility that may be left. 

Corvisart mentions, among the various morbid 
appearances observed by him in those who died 
in consequence of disease of the heart, the high 
vascularity of the stomach. To such extent does 
this at times proceed, that, as he correctly states, 
the stomach will be nearly filled with sanguineous 
clots of a deep red colour, extending also through- 
out the small intestines. I am induced to dwell 
upon this phenomenon, with which indeed my 



112 DISEASES OF THE HEART. 

pathological inquiries have long made me familiar, 
principally from its singular importance in forensic 
medicine ; although it is of no slight moment on 
other accounts. 

" Dr. Ramadge gives an account of a very 
interesting trial occurring some years ago ; the 
parties in which were the Rock Insurance 
Office, and the executors of a respectable banker. 
His death had been sudden ; and on opening his 
body appearances were presented, which induced 
the suspicion that the deceased had made away 
with himself. More than one hospital surgeon of 
eminence gave it as his opinion, that the individual 
in question had taken poison. Their authority 
would, in fact, have influenced the Jury, had not a 
young medical practitioner, a former pupil of mine, 
decided the point at issue, by counter-evidence. 
It was, indeed, evident to the pathologist, from the 
detail of the circumstances, that the deceased had 
laboured under some obstruction to the circulation, 
whence arose the congested state, and discharge 
of blood, which had misled the other medical 
witnesses. 

Now the phenomenon, which I have just no- 
ticed, may be presented after death from another 
cause, which, however, produces precisely the 



DISEASES OP THE HEART. 113 

same results as cardiac disease, namely, inflam- 
mation of the lungs. As an instance of this fact, 
I may adduce the 'post mortem examination of his 
late Majesty ; and I recommend the considerations 
I shall have to make on this subject, to the especial 
notice of our honoured President, Sir Henry 
Halford. If I am wrong, he will correct me ; and 
he cannot have a more graceful, or loyal opportu- 
nity, of making public those pathological inquiries 
to which doubtless his life has been unremittingly 
devoted. 

From the report made after death, to which was 
appended the name of that truly eminent surgeon, 
Sir Astley Cooper, it would appear that this gen- 
tleman referred the phenomena, presented on dis- 
section, to disease of the heart. 

This opinion is undoubtedly correct. Disease 
of the heart did produce some aberrations from 
healthy structure therein noticed. But, through 
tenderness, I presume, for his Majesty's more 
immediate medical attendants, he omitted to men- 
tion, that the aggravated symptoms of this disease, 
which, as he truly observed, " had existed for 
many years/' were secondary, not primary causes, 
of such morbid phenomena. Accordingly, the 
President, knowing that Sir Astley's name is " a 

10* 



\ 

1 14 DISEASES OF THE HEART. 

tower of strength," gave out afterwards that 
cardiac disease was the ".fons malorum" Yet, 
such being his opinion, it is extraordinary that he 
should not have remonstrated against his Majesty's 
frequent drives in Windsor forest, in the severest 
weather, previously to increased indisposition con- 
fining him to his apartment. He must, of course, 
have been aware of the pre-existence of his cardiac 
complaint ; since although the President, I believe, 
does not employ auscultation, a careful exploration 
of their patient's chest, must doubtless have been 
made by one, or other, of the remaining medical 
attendants. Still I do not find, from his diagnosis, 
(so far as this is to be gleaned from the bulletins) 
that he had any suspicion of an affection of this 
organ, previously to death. The said bulletins 
were indeed most " ambiguous givings out ;" and 
were characterized, at the time, by Mr. Brougham, 
(the late Chancellor,) in rather severe terms. I 
forget the particular expressions of which he made 
use, but their tenor was, that so deceptive and 
unmeaning were those official documents, he 
defied any man to lay his hand upon a single 
passage from which the prospect of the event, 
deplored by the whole nation, could have been 
gained 



DISEASES OF THE HEART. 115 

Supposing, however, that he did entertain the 
belief of his Majesty's labouring under some 
affection of the heart, I am totally at a loss to 
account for his apathy in permitting those repeated 
airings, of which the newspapers made at the time 
consant mention. 

It is a fact, that on the sudden setting in of cold 
weather, numbers of elderly persons suddenly 
succumb to the manifestation of disease of the 
heart. This has long been observed in those 
establishments (at least I have noticed it) in which 
the aged are congregated together, as at our noble 
institutions, Greenwich and Chelsea hospitals. 
The reason is very apparent. Cold at once con- 
stringes the cutaneous capillaries, and thus operat- 
ing on the deep seated vessels occasions a conges- 
tion which the heart, called upon to exert fresh 
activity at a period when time, or disease, has 
enfeebled this vital organ, is unable to overcome. 
To use a technical illustration, an additional 
leverage is exerted, and the spring snaps. 

Against the above account it may be objected, 
that dissection furnished evidence of cardiac lesion. 
The vascularity of the stomach, as I have already 
remarked, is no proof of the existence of disease 
of the heart ; but what did exist had, doubtless, 



116 DISEASES OP THE HEART. 

been called into activity by the unsuspected in- 
flammation of the lungs. 

In fine, as no diagnosis was recorded, it is pre- 
sumable that no diagnosis was made, at least none 
that had careful exploration of the chest, by 
auscultation and percussion, as its basis. The 
evils, resulting from such omission, may be con- 
jectured from the preceding remarks. 

By way of corollary to the above, and as an 
example of how confined the knowledge of pa- 
thology is, or else of its difficult acquisition, I may 
mention that about two years previously to the 
demise of his Majesty, 1 had had some prepara- 
tions made, at a considerable expense, faithfully 
imitating the stomachs of persons who had died 
of the consequences of cardiac disease. These 
preparations were shewn by the modeller to some 
of the most eminent in the profession, and in one 
case, to a gentleman who, he stated, was preparing 
to publish a work on the morbid appearances of 
the stomach in individuals destroyed by poison. 
They all pronounced the subjects, from whom the 
preparations were modelled, to have lost their 
lives by poison, or some acrid substance taken into 
the stomach. 

In the report of the autopsy, on the body of his 



DISEASES OF THE HEART. 117 

Majesty, it is stated that the immediate cause of 
his death was the rupture of a biood-vessel in his 
stomach. To this I can give no credence. The 
effusion was, I make no doubt, poured forth 
from the muco-villous coat of the stomach. It is 
generally supposed that the vasa brevia supply a 
channel for sanguineous congestions by the com- 
munication they furnish with the splenic end of 
the stomach ; but in addition to this passage, I 
believe the vascular pores of this organ itself must 
facilitate the escape of effusion. This, however, 
is contrary to the opinion of Corvisart, who sup- 
poses that the liver unloads itself of its accumulated 
blood, through the intervention of the hepatic 
arteries and veins, and the pori biliarii, into the 
hepatic duct, and that the fluid conveyed by this 
means into the beginning of the duodenum, may, 
in part, flow back into the stomach. Now, fre- 
quently as I have examined the hepatic duct, both 
before and since my acquaintance with Corvisart's 
work, I have never been able to detect the pre- 
sence of any sanguineous collection there. 

The course of the disorder which terminated 
his Majesty's life seems to me briefly this ; and I 
ground my opinions on the few hints to be gleaned 
from the President's bulletins, and the details of 



US DISEASES OF THE HEART. 

the examination after death. Cold, I conceive, 
induced inflammation of the lungs, which was 
latent, but could have been readily discovered by 
an experienced auscultator. The absence of cough, 
till within a few days preceding his demise, by 
no means invalidates the above supposition, as 
experience has fully shown me; and the difficulty 
of breathing, so often mentioned in the bulletins, 
tends to confirm it. 

Consecutive hydrothorax first occurred in the 
left side of the chest (between two and three 
quarts of water were found after death) and the 
compression of the lungs, produced by this effu- 
sion, might in some degree, mask to the inexpe- 
rienced, the auscultative signs of pneumonia. Had 
bleeding been seasonably employed, effusion could 
not have well occurred ; and, as a proof of the 
inestimable value of auscultation, I must beg espe- 
cial attention to the fact that venesection, critically 
applied, might not only have prevented the depo- 
sition of water in the chest, but had it been again 
resorted to at fitting periods, it would have obviated 
the sanguineous effusion from the stomach. This 
latter, indeed, arose from the general venous con- 
gestion brought on by the compression of the lungs 
just noticed. 



DISEASES OF THE HEART. 119 

In the outset of this digression, I have taken 
the liberty of calling Sir Henry's attention to it. 
Although, conjecturing from the <<■ aniles fabel- 
las," or short essays he has published on medical 
subjects, I am fearful that these are details which 
possess little attraction for him. In' one of his 
prolusions, at the conversazioni if I mistake not 
held at the College of Physicians, he speaks of 
individuals' having suffered from palsy of the 
kidneys. This is so extraordinary, that one would 
suppose the curiosity of the learned President 
would have led him to examine these organs, in 
order to satisfy himself whether, or not, they had 
undergone any change of structure. Doubtless he 
knew, without examination, the morbid condition, 
as well as functional derangement, of these poor 
palsied kidneys. It would, however, have been 
kind in him, to have stated them for the benefit of 
individuals less favoured by nature. 

Before dilating further on the President's mul- 
tifarious endowments, it behoves me to apologize 
for having, although I trust in no irreverent spirit, 
invoked the names of royalty; yet, I am but 
following, although at immeasurable distance, 
" non passibus xquis" the steps of the President 
himself. It is his delight, and 1 humbly hope the 



120 DISEASES OF THE HEART. 

delight of his auditory likewise, to dwell upon the 
" last, long, lingering" scenes of royalty. Seldom 
does one of those evening parties occur, at which 
science, tea, and coffee, hold divided empire, but 
he favours his hearers with an account of the 
patience and resignation of those illustrious per- 
sonages, who have died under his hands. 

How far the interests of medicine may be ad- 
vanced by these reunions, at which the courtly 
President delivers his popular harangues, it be- 
comes not me to decide. Judging from what have 
already appeared in print, I should conclude that 
I am no very serious loser by my absence from 
these high solemnities. I cannot, indeed, conceive 
how any scientific advantages can possibly accrue 
from meetings, at which are assembled " throned 
dominations, princedoms, virtues, powers," at 
which, in short, a number of individuals profound- 
ly ignorant of medicine, in company with those 
who by virtue of their diplomas do, I should con- 
jecture, know something of the matter, congregate 
to listen to some popular essay on the gout, 
insanity, &c, or observations on the charms of a 
death-bed under the auspices of Sir H. Halford. 
Such meetings may tend to introduce some half- 
dozen sucking favorites of the Galenical Sultan's 



DISEASES OF THE HEART. 121 

to promising patients, and gratify personal vanity 
at the same time. The non-professional hearer 
will take oratorical common-places for the dicta of 
an Hippocrates, and the initiated will be wiser 
than to gainsay his e^a st-tepospta. 

But seriously speaking, is this a state of things 
which can, or ought to exist ? Was the college of 
Physicians founded for no higher purpose, than to 
furnish forth an evening's entertainment? Pro- 
perly directed, it might become the central point 
around which the real talent of the kingdom might 
be collected. Bestowing countenance, and pro- 
tection, on the young and zealous, and made the 
depository of every fresh accession of knowledge 
gained by the experienced, it might rise higher 
than personal views, and by enlarging the sphere 
of science, lessen the ills of humanity. But to 
effect this, or any thing approximating to it, the 
high places, with the images of Baal, must be 
overthrown. Wealth, and fortuitous success, must 
no longer give a patent right to the office of 
President. Fair, and open competition, should 
here, as on the continent, give the highest seat to 
the worthiest. The man, who has at his disposal 
the most valuable situations in the reach of the 

11 



122 DISEASES OF THE HEART. 

profession, should have medical knowledge no 
less than integrity to direct his choice. 

I fairly own that when I regard the men, pre- 
eminent in skill, and therefore, therefore alone, 
pre-eminent in rank, who adorn the profession 
abroad, I feel not a little ashamed of the figure we 
make at home. The estimability of private cha- 
racter cannot compensate for the want of distin- 
guished professional reputation, in the nominal 
head of the medical schools of this country. 
Surely the ephemeral sheets, published by Sir 
Henry, could not, by his most obliged partizan, 
be compared, without a blush, with the masterly 
productions — translations of which form the rich- 
est part of our medical libraries. Did I know 
one offering laid on the shrine of science by the 
President, I would willingly give him the credit 
due. I attack not the man, but the system, 
which imposes the man upon us. When I am 
informed of any one discovery, in either the 
theory, or the practice of medicine, first com- 
municated to the world by Sir Henry, I will pro- 
claim him — a better man than many of his prede- 
cessors in the chair. Yet let me not be too pre- 
cipitate in my judgment. His present publication 



DISEASES OF THE HEART. 123 

may be merely the forerunner of some great 
posthumous work, which may call forth our re- 
grets when its author is no more. The boon 
denied us now may be vouchsafed to posterity ; 
and future generations may hail, with reverence, 
that name by which at present 



Devisor vero plus laudatore movetur. 



9 >9 



1 am unacquainted with any member of the 
medical profession on this side of the Atlantic, who 
betrays in practice so much ignorance of sympto- 
matology or pathological anatomy. Had William 
the Fourth been surrounded by men devoted to 
medical acquirement, and possessed of less desire 
to relate the death-bed resignation of some patient 
of rank, perhaps he might have still enjoyed his 
rides in Windsor Park. 

The treatment of the disease which closed the 
life of President Harrison, was severely criticised 
by some member of the medical profession in New 
York, and perhaps justly. In Philadelphia we 
were informed that the President was ill with in- 
flammation of the lungs, but we had no account 
of his being bled freely ; every niail brought us 
the sad tidings of his disease progressing from bad 
to worse, until finallv his demise was announced. 



124 DISEASES OF THE HEART. 

There is a fact long established in practice with 
regard to blood-letting, that persons advanced in 
life bear bleeding better than acute inflammation ; 
and it will generally be found, that acute inflam- 
matory attacks will often yield more readily in 
advanced than early life ; one or two free bleed- 
ings will generally put an end to all danger from 
inflammation, and completely prepare the system 
for internal remedies, which may be indicated by 
derangement of any of the functions. After free 
blood-letting in old persons we should re-establish 
the healthy action of the constitution by the use of 
the mildest means. We should select articles of 
medicine that would fully accomplish what we 
desire to perform without debilitating the patient, 
or causing the least irritation. We should never 
rely on antimonials to remove inflammation ; the 
tone of the stomach should be assiduously guarded. 
In most cases the bowels may be acted upon by 
enemas alone, or assisted by food that will have 
the same tendency. It has been remarked by 
others, and often witnessed by myself, that anti- 
monials frequently reduce the patient but not the 
disease. Where blood-letting has been early and 
judiciously practised, there will be no necessity for 



DISEASES OF THE HEART. 125 

antimonials ; and when the lancet has been with- 
held nauseating doses can be of no avail. 

I have met with many physicians, who having 
lost patients with acute disease attended with some 
irregularity of pulse, concluded that no treatment 
could have resulted otherwise, in consequence of 
the existence of some latent affection of the heart. 
I have known certificates given, " died of diseased 
heart J' when the subject had enjoyed a long life of 
uninterrupted health free from irregularity of the 
heart's action, until the commencement of the 
disease that had proved fatal. I do not wish to be 
understood to say, that diseases of the heart never 
occur ; but I do say, in my opinion they are de- 
cidedly more apt to be symptomatic, than idio- 
pathic. 

I have attended a lady in this city for the last 
fifteen years, who from derangement of the liver, 
has frequent attacks of dysenteric discharges from 
the bowels, and while this disease lasts, which is 
generally from two to three weeks, her heart beats 
with great irregularity, her pulse consequently in- 
termits, she has frequent syncope — and this state 
of things exists as long as the bowels continue 
deranged: but when remedies triumph over dis- 
ease, and this disordered state of the bowels is 

11* 



126 DISEASES OF THE HEART. 

completely subdued, I find the fountain of the cir- 
culation moving on with the same healthy regu- 
larity, that had existed previous to the attack. 

I have at this time a young lady under my care 
whose heart (according to the opinion of her former 
physician) was so diseased, that nothing could be 
done for her relief. When she became my patient, 
I gave her case all the attention it demanded ; 
I examined the lungs, the heart, the stomach, the 
spine, &c, and gave a written opinion to her 
friends sealed up, with this remark, that I would 
not pass judgment upon the discrimination of her 
former physician, until some one of our city prac- 
titioners had seen the case. The selection was 
left to the family, and Dr. S. Jackson was their 
choice, who frankly stated, after auscultation, per- 
cussion, &c, that the heart was free from disease, 
and in his opinion, its regularity could be esta- 
blished, by attention to the spine, the nervous 
system, and the bowels. This statement corres- 
ponding with my written opinion, the seal was 
broken and the family perfectly satisfied. The 
treatment for spinal irritation commenced and the 
improvement progresses daily. 

I consider diseases of the heart extremely rare, 
while inflammation of its covering, (the pericar- 



DISEASES OP THE HEART. 127 

dium) more frequently occurs. This disease is of 
the same nature as inflammation of the pleura, 
though often more violent ; blood-letting should be 
boldly performed, and the general antiphlogistic 
plan of treatment rigidly practised. This kind of 
inflammation often terminates by effusion, the 
fluid in the cavity of the pericardium is thus in- 
creased in quantity, the heart labors, its action 
becomes irregular, its vibrations yield a dull sound 
upon applying the stethoscope, the pulse grows 
weak and intermits, while the individual is said to 
have disease of the heart: under these circum- 
stances, if we direct a spare diet, daily exercise, 
and a compound of squills, digitalis, and elaterium, 
in small doses, the symptoms will soon change for 
the better, until finally the patient declares himself 
free from disease. 

The heart itself is sometimes diseased in its 
organic structure ; the labors of Lancici, Morgagni, 
and Senac, threw much light on this subject : and 
many late writers have added useful information 
to this branch of medical science. The present 
mode of discriminating by auscultation, ensures a 
more perfect knowledge of cardiac diseases, than 
the ancients practised: but the inexperienced ear 
will frequently hear sounds produced by healthy 



128 DISEASES OP THE HEART. 

vibrations that are often mistaken for disease. 
Corvisart made many discoveries in diseases of the 
heart, but they were for the most part confined to 
organic lesions : he probably made use of mediate 
auscultation ; or perhaps, his cases frequently ter- 
minated fatally, and lesions were discovered by 
autopsy. It was asserted by Vieussens at an early 
period in the last century, and soon afterwards by 
Thebesius, a German Professor, that there were a 
number of small orifices in the texture of the 
heart which opened into the different cavities on 
both sides of it. The assertion of a fact so difficult 
to reconcile with the general principles of the cir- 
culation, was received with great hesitation : and 
although it was confirmed by some very respecta- 
ble anatomists of the last century, it was denied 
by others. The subject was brought forward by 
Mr. Abernethy, (see London Philosophical Trans- 
actions for 1 798, Part I.; who states, that he has 
often passed a coarse wax injection from the 
proper arteries and veins of the heart into all the 
cavities of that organ, and particularly into the 
left ventricle. But it was only in subjects with 
diseased lungs that this was practicable. 

The existence of this communication between 
the coronary vessels and the great cavities of the 



DISEASES OF THE HEART. 12.9 

heart seems therefore to be proved. The easy 
demonstration in such subjects is ingeniously re- 
ferred by Abernethy to the obstruction of the 
circulation in the lungs : and he regards the com- 
munication as a provision, enabling the coronary 
vessels to unload themselves, when the coronary 
vein cannot discharge freely into the right auricle. 

I have met with but few cases of chronic disease 
of the lungs, where there was not more or less 
disturbance of the heart; a frequent and often 
irregular pulse is a common attendant on chronic 
pulmonary disease, even at a period in the day 
while fever is absent. When masses of tubercles 
exist in the lungs, or large abscesses, or tumors, 
causing obstruction in their circulation, we always 
find an irregular pulse : and by removing these 
causes we soon discover improvement in the con- 
dition of the circulation. 

Palpitations of the heart frequently exist without 
any organic affection ; its violent commotion is 
often a source of great annoyance to the patient, 
and may frequently be heard some distance from 
the individual laboring under this symptom. I 
have at this time a patient under care, whose 
heart, in the beginning of her indisposition could 
be heard pulsating ten feet from the bed side ; 



130 DISEASES OP THE HEART. 

this violent action subsided under the use of an 
infusion of digitalis, and a powder composed of 
oxide of bismuth, rhubarb and ipecac, which 
was continued for three months, occasionally 
omitting the digitalis. Dyspepsia was in this case 
the sole cause, which yielding to the above medi- 
cine and a well regulated diet, the palpitation was 
soon removed and. the patient returned to ordinary 
health. 

Certain positions of the body, obstructing the 
free circulation in various parts, will often occasion 
derangement of the heart's action ; and if not at- 
tended to may often lay the foundation of disease. 
Clerks in banks and counting-houses are frequently 
subject to these disorders from leaning over, or 
upon their writing desks : and children in many of 
our seminaries, frequently have curvature of the 
spine and deformity of the chest, produced in the 
same way. The desks upon which they rest their 
arms, should be nearly on a level with their shoul- 
ders, and their seats should always be supplied 
with high backs, upon which they should be 
directed to lean back, when occupied with 
study. No term in the day should exceed two 
and a half or three hours; and large seminaries 
should always be provided with one large room 



DISEASES OF TfflE HEART. 131 

as a place for exercise, where the pupil can be free 
from restraint, and jumping ropes, horizontal 
bars, dumb-bells, &c, should be kept for their use. 
In this way we might hope to avoid many diseases, 
and improve the rising generation. The heat of 
this apartment should be less than that of the 
school-room, the temperature of which should 
never exceed sixty-five degrees Fahrenheit. In 
mild weather the open air would be preferable for 
exercise. For a minute description of heart dis- 
eases, I refer the reader to the works of Laennec. 
I would remark in conclusion of this chapter, 
that individuals laboring under chronic disease of 
the heart, or enlargement, are much benefited by 
attention to a spare diet, and in all cases by avoid- 
ing excitement of the mind. Abstemiousness in 
food, rigid renunciation of stimulating liquors, 
and above ail, peace of mind are indispensable to 
ensure recovery in all the affections of the heart. 
It is in the treatment of these diseases that the 
physician must add to the routine of his art, the 
higher offices of the philosopher and Christian. 
Without a knowledge of the world, and the work- 
ings of the human bosom he will be often incom- 
petent to counsel ; without that faith, which alone 
" makes wise unto salvation" he will be unable to 



132 DISEASES OF THE HEART. 

soothe, strengthen, and console ; and he who has 
not those qualifications which enable him to be- 
come the moral teacher and the friend, may in the 
majority of these diseases, as well " throw physic 
to the dogs" as prescribe for the body when it is 
the vassal of the mind. 






ASTHMA. 



This term, though indefinite, still continues to 
be employed by the scientific as well as the uned- 
ucated ; though asthma not unfrequently exists 
under the name of phthisic, a term often used in 
some parts of the country. " Difficulter respirare," 
is perhaps as significant a name as we can give 
asthma under its varied forms. A name can be of 
little importance to an individual suffocating with 
asthma, and yet a name will frequently relieve a 
patient or destroy the peace of a whole family. 

Among nosological writers names have pro- 
duced much confusion, and as a necessary conse- 
quence have led to a similar result in practice. 
What one nosologist considers a cause, another 
describes as an effect ; and medicines highly ex- 
tolled by one physician, are often decried by 
another. 

12 



1 34 ASTHMA. 

Attempts have been made by writers from the 
earliest history of medicine to distinguish asthma 
from other diseases of the chest, and this end was 
supposed to be attained, by terming a slight diffi- 
culty of breathing dyspnoea, and laborious respi- 
ration asthma. The moderns recognise two pri- 
mary species — the spasmodic and the humoral. 

The parenchyma of the lungs is seldom if ever 
affected by the disease, while the mucous mem- 
brane will invariably be found to be its seat, having 
its remote cause in the digestive organs primarily, 
disordering the nervous system, and through this 
connection, affecting the lining membrane of the 
bronchial tubes. In this way the system is con- 
tinually predisposed to attacks, and when exciting 
causes occur, such as wet feet, exposure to a damp 
and cold wind, or a location in a low and marshy 
section of country, the disease will be produced. 
Or derangement of the nervous system, pro- 
ceeding from other causes may produce asthma, 
independent of disordered digestion. A remarkable 
case of this kind occurred to me in 1837. A 
gentleman in Pittsburg, having received a severe 
blow upon the back, near the sixth dorsal vertebra, 
from the falling of a brick while passing under a 
scaffold erected in front of a new building, was 



ASTHMA. 135 

immediately seized with great difficulty of breath- 
ing, strongly resembling spasmodic asthma. His 
physician pursued the best treatment for his relief, 
which was soon obtained ; he was bled freely, 
and repeatedly leeched on the contused part of 
the back ; purgatives and anti-spasmodics were 
used with a mild diet : under this treatment the 
patient soon recovered. 

At the expiration of six weeks from the acci 
dent, his breathing became oppressed, and now 
assumed the decided character of asthma, which 
yielded to the application of forty leeches to the 
spine, and large doses of gum foetid. His third 
attack was as punctual, as to time, as the second 
had been, six weeks having again elapsed : this 
third attack occurred while on a visit to our city, 
and I was called to visit him during the paroxysm. 
He gave me the above history of his case, and 
declared his digestion had never been out of order 
in the least. Upon examination of the spine I 
was at once convinced of the fact, that the shock 
received by the sympathetic nerves, had been 
sufficient to occasion all the inconvenience from 
asthma which this patient suffered ; and as he had 
been repeatedly leeched, I presumed all the benefit 
that could be obtained from this remedy the 



136 ASTHMA. 

patient had experienced. I, therefore, applied 
moxa about three inches above and below the 
tender spot on the back, and slight galvanic shocks, 
and eight drops of Fowler's solution to be taken 
night and morning. This attack subsided in half 
an hour after the application of the moxa and 
galvanism, when the patient observed that he had 
found the right thing at last. These sores were 
kept open with Savin ointment, and the solution 
continued with galvanism for twelve days. He 
returned home in the third week after my treat- 
ment commenced, and has had but one slight 
attack since that time ; this occurred at the expi- 
ration of the first six weeks from his visit to our 
city. After a lapse of five months he suffered the 
sores to heal. 

Asthma in my opinion is originally spasmodic ; 
becoming humoral either from being connected 
with some latent inflammation, or from long con- 
tinued habit. There is doubtless a third species, 
namely from gout, which will generally be found 
to be hereditary. This we should try to fix in 
some part less necessary for the functions of life. 

Sauvage has employed the word suspirium, 
used by Celsus and Seneca, as a general term to 
designate asthma. Independently of this authority, 



ASTHMA. 137 

it has perhaps a claim to admission into the medical 
vocabulary from being identified with the person 
of Virgil ; and this moreover, through the pleasant 
observation of Augustus, who alluding to the 
asthma of the epic poet, and the weak eyes of 
Horace, when seated between them at the table, 
observed that he was "inter suspiria et lachrymas," 
(between sighs and tears.) 

The treatment I have found most beneficial, has 
been that which was required for the correction of 
disorders which may be its cause. Derangement 
of the liver, of the uterus, of the bowels, stomach, 
spine or brain, with injuries of the bony walls of 
the chest, predispose to, while irregularity in 
sleeping, eating, clothing, and weather excite the 
disease. These causes can all be removed by 
proper medical treatment, and great care on the 
part of the patient. 

The dyspnoea requires, during an attack, some 
relief, which will always be obtained by taking 
small doses of the tincture of lobelia and ether, and 
inhaling a mixture of oxygen and etherial va- 
pour. 

My practice in asthma has invariably been, to 
remove the predisposing cause of the disease ; when 

12* 



138 ASTHMA. 

this is accomplished, 1 have generally found its 
exciting causes were harmless. 

I shall conclude the subject of asthma, by intro- 
ducing some of Dr. Ramadge's remarks, taken 
from his able work on that disease. 

"In its uncomplicated state Asthma, as has 
been observed, is of very rare occurrence. Since, 
too, it seldom or ever proves fatal, the pathology 
of this, the spasmodic form, is altogether conjec- 
tural. Many physicians, indeed, deny the exist- 
ence of a purely nervous species. The correct- 
ness of this opinion will be examined hereafter. 
At present, we shall assume the reality of such a 
disease, and proceed to detail its ordinary symp- 
toms. 

The peculiarity of this form consists in the 
suddenness of its attack, so that no warning would 
appear to be given. Its ordinary fore-runners, 
when "note of preparation" is sounded, are 
mental anxiety, extraordinary exertion of any 
kind, sudden changes in the weather, disagree- 
ment of food, and, in short, whatever operates 
mediately, or immediately, upon the nerves. 
Thus, it is apparent, that the proximate cause of 
the spasmodic asthma, must, with that of most 



ASTHMA. 139 

nervous disorders, remain unknown, until we can 
resolve that mysterious connection betwixt the 
mind and body, which, it seems probable, will 
ever baffle alike the physiologist and the philoso- 
pher. 

The symptoms, with which the attack com- 
mences, are a sense of general oppression, more 
particularly in the head and chest. The eyes are 
affected much in the same manner as in common 
cold ; and there is a feeling of weight and fulness 
about the pit of the stomach. The patient is heavy 
and languid ; disinclined to exertion, drowsy, and 
apt to fall into disturbed and uneasy slumber. In 
some cases, a day or two preceding the attack, the 
patient is sensible, a short time after dinner, of a 
feeling of weight and over-fullness in the region of 
the epigastrium, and the stomach is swollen and 
distended with wind. From the disturbance given 
to the digestive functions, the eructations are 
usually acid or insipid. Floyer observes, that he 
noticed in himself the spasmodic state of the lungs 
to be so much the more supportable in proportion 
to the spasm of the intestinal canal, marked by 
the gaseous distension, extending itself to the 
lower bowel. 

As the respiration becomes more difficult the 



140 ASTHMA. 

pain at the chest increases, and the constriction is 
at last so intense as to be compared by the sufferer, 
to what might be supposed to arise from cords 
bound tightly around it. Jt heaves and dilates as 
if striving to burst these imaginary bonds, and is 
again compressed, as it were, by their violent re- 
action. The stupor and heaviness, at first felt in 
the head, are not unfrequently replaced, as the 
attack approaches its height, by severe headach. 
Slight fever is occasionally present with its usual 
concomitants of thirst and restlessness ; as are also 
dryness, corrugation and pallor of the skin. Cough, 
of a strictly convulsive nature, seldom at first 
accompanied by expectoration, comes on, and 
harasses the patient by its frequency and violence. 
It appears to the patient as if his lungs were 
pushed to the top of the thorax; a number of 
muscles, and indeed the whole muscular apparatus 
is exerted in aid of the muscles of inspiration, and 
sometimes with such efforts that convulsions, and 
even epileptic symptoms, are the result. 

A deadly paleness now overspreads the coun- 
tenance ; the extremities turn cold, and the wheez- 
ing, which accompanies each expiration, is audible 
at the distance of several yards. The sufferer 
literally gasps for breath ; the blood vessels of the 



ASTHMA. 141 

eyes become swollen and turgid by the violence of 
the cough ; and the eyes seem ready to start from 
their sockets. To speak, at this stage of the 
paroxysm, is impossible, or if effected, the effort is 
agony. Even to make a sign with the hand is a 
distressing exertion ; and to add to this complica- 
tion of agony, the most even-tempered will at this 
crisis become fretful and peevish ; and a gesture 
misinterpreted calls forth a manifestation of pas- 
sion, and with it an aggravation of every distress- 
ing symptom. It not unfrequently happens that 
the mind participates in the highly-wrought excite- 
ment of the body, and adds a train of imaginary 
terrors to the real tortures which rack the patient's 
frame. A thousand ills, conjured up by the 
morbid state of the mental faculties, not only 
harass the patient in themselves, but by their re- 
action super-add to the extremity of his suffering. 
Of course, it will be understood that all these 
symptoms are not always present; but some or 
other of them form the general characteristics of 
Nervous Asthma. 

In the generality of instances, the attack com- 
mences towards evening, and after retiring early 
to bed from the lethargy, which I have mentioned 
as one of the primary phenomena, the patient is 



142 ASTHMA. 

suddenly awakened in a few hours by a feeling of 
strangulation, and finds that the fit has seized him 
with all its violence. Occasionally, however, the 
asthmatic will, after awakening, lie in a half- 
dreamy, half-conscious state, sensible in some sort 
of the approach of the attack, and yet indisposed 
to rouse up and strive to ward it off by having 
recourse to preventives. When fully awake, he 
finds an oppression of the chest, weighing him 
down like an incubus, and is constrained to sit up, 
or to quit his bed at once, if, as he imagines, he 
would escape suffocation. One of the most ordi- 
nary symptoms of this disease is an unusual flow 
of urine of a pale colour ; but at the termination 
of the attack it becomes high coloured, and de- 
posits a sediment. In fits of short duration, on 
the contrary, such a limpid state of urine is seldom 
observed ; and the most inconvenient symptom is 
that of flatulency. A few hours generally bring 
such fits to the close, and relief is first indicated 
by the expectoration becoming copious. A dispo- 
sition to sweat, and irregularity of pulse, are like- 
wise concomitants of these short attacks ; which 
are free from the proneness to sleep before noticed. 
Frequently, these attacks are repeated at intervals 
of one or two days, or more, for some period. In 



ASTHMA. 143 

such cases the pause, or intermission, between each 
attack, consists of an abatement of the more 
violent symptoms, rather than a cure. The patient 
will, from the delightful contrast presented by 
present ease to his recent suffering, feel light of 
heart, and imagine his restoration to health per- 
fect; but a nice observer can easily detect in- 
completeness and general irregularity of respira- 
tion. 

It deserves notice, that the violence of the 
symptoms increases, instead of diminishing, at 
each successive paroxysm, until the attack has 
run half its course ; and that after this the remis- 
sions are longer, and more perfect, until the 
termination of the fit. When the nervous habit 
is once established, that is to say, when at some 
determinate period, or periods of the year, the 
fits recur, whether in winter or summer, or more 
frequently, the intervals elapsing between them 
are not times of complete health. Many indices 
present themselves to the physician of some disor- 
dered state, still existent in the asthmatic. Aretaeus 
expressly says, " in morbi cessationibus licet ipsi 
non decumbentes obambulent, secum tamen illius 
signam ciecumferunt ;" and indeed, in many 
instances, the countenance, gait, and manner of 



144 ASTHMA. 

the patient, indicate but too truly the disease under 
which he labours. Without however going the 
length of the ancient, but most accurate observer, 
just quoted, it is certain that some functional 
derangement, or some confirmed local disease may 
generally, if not invariably, be traced in the asth- 
matic. In cases of mal -conformation of the chest 
there is an obvious cause ; but in the absence of 
every other easily discerned symptom a shortness 
of breath, made evident by the slightest extra 
exertion, will prove the asthmatic diathesis. Few, 
however, who suffer from this disease, are affected 
in precisely a similar manner. The symptoms 
are as various, as the causes are usually stated to 
be ; and the variations in the duration, and recur- 
rence of the fits, are equally as anomalous. In 
some, the nervous habit assumes a regular charac- 
ter, and its periodic return are duly' anticipated 
by the patient. In the great majority of cases, 
however, much uncertainty prevails on these 
points. 

Independent of the constitutional habit, there 
are a variety of secondary causes, which have 
more or less influence in retarding, or accelerating 
the attacks. For instance, if summer be the 
period of suffering, (and this is the more frequent 



ASTHMA. 145 

form in the purely nervous asthma,) excessive heat 
may bring on the commencing fit as early as the 
end of May ; but if the weather be cool, it may 
keep off till the close of June, or beginning of 
July. In winter again, the early setting in of the 
frost, or as the case may be, a continuation of a 
close, foggy state of the atmosphere, will exert a 
marked influence on the early or late appearance 
of the disease, when it co-exists with catarrh. 
The most violent and frequent attacks occur soon 
after the summer solstice. 

On the abatement of the paroxysm, when it has 
been severe and of long duration, a sense of sore- 
ness, arising from the straining and unwonted 
exertion of the respiratory muscles, is usually left 
for some hours subsequently. Both during the 
attack, and after its violence is abated, there is a 
painful feeling of fulness, and of undue distension, 
in the region of the two solid, floating viscera of 
the abdomen, the liver and the spleen. This state, 
as well as flatulence, and headach which I have 
mentioned as symptoms, and attendants, of asthma, 
are, in a certain degree, owing to venous conges- 
tion. The flatulence, which medical writers gene- 
rally put down as a precursory symptom of asthma, 
is not, I have long remarked, apparent, until a 

13 



146 ASTHMA. 

succession of fits has established the dyspeptic 
habit in the patient ; which is the result of the 
obstruction to the circulation of the blood in the 
chylipoietic viscera, arising indirectly from the 
congested or compressed condition of the lungs. 
To enter more minutely into the causes leading to 
this mechanical hyperemia. In all varieties of 
asthma lesions of circulation may be traced ; and 
to place the subject in a more distinct light, I shall 
quote a passage from my Treatise on Consumption, 
explanatory of the happy effects resulting from 
free respiration, in order by this contrast to give 
a clearer view of its contrary. 

< The mere expansion of the lungs in the first 
instance, tends indirectly to remove congestion of 
the liver, and also of the stomach, spleen, pancreas, 
and intestinal canal, all dependent on the more 
free circulation of the blood in the former. The 
biliary, as well as the great salivary secretion, is 
hereby promoted to a healthy activity. Such 
morbid irritability of the mucous membrane of the 
stomach as may be present, productive of indiges- 
tion, is removed; the chyliferous absorption be- 
longing to the small intestines, so indispensable to 
life, is actively carried on, and the injurious reten- 
tion of excrementitious matter in the large intes- 



ASTHMA. 147 

tines, is obviated by increased mucous moisture, 
and accelerated peristaltic motion.' 

I now proceed to the contrast ; and do not know 
that I can explain the mechanical hyperemia 
existing in asthma better than by the following 
passage from the same work : — 

' The blood of the right ventricle of the heart not 
finding a ready passage through the lungs, afflicted 
as above-mentioned, causes a preternatural quan- 
tity of the same fluid in the adjoining auricle, and 
especially in the two great veins opening into it. 
The consequences of this state are head-ache, 
owing to the interruption of the free return of 
blood from the head; pulmonary engorgement, 
through the difficulty the bronchial veins expe- 
rience in transmitting their blood, by either its 
direct or circuitous course, into the vena azygos; 
and serious derangement, or actual disease, of the 
most important viscera of the abdomen. The 
superior cava, preternaturally full of blood, will, 
by retarding that fluid in the jugular veins, pro- 
duce pain in the head ; and, by a similar»interrup- 
tion to the circulation of the vena azygos, besides 
interfering with the free return of the blood into 
the bronchial veins, it will, in some degree, impair 
the activity of the kidneys ; the due return of the 



148 ASTHMA. 

effete blood of which organs depends on the 
freedom with which it is conveyed from the vena 
azygos into the vena cava superior.' — P. 80. New 
Edition. 

Pursuing this train of observation it will not, I 
think, be unphilosophical to suggest that the great 
debility accompanying asthma may originate, in 
some degree, from the want of a due supply of 
blood to the left side of the heart, and its arterial 
system. 

Having thus presented the ordinary symptoms 
of the disease, it remains to ascertain the state of 
the respiration afforded by means of auscultation. 
No disease presents more anomalies in its auscul- 
tative diagnosis than asthma. This partly arises 
from the longer, or shorter period, during which 
the patient has been asthmatic, and is partly owing 
to other causes of a pathological nature. It has 
been stated that the inspiration yields little or no 
sound ; but in most cases of nervous asthma 
examined by me, I have detected the presence of 
a more *than ordinary mucous secretion in the 
trachea, more or less audible. Spasm of the 
posterior membrane of the trachea, as well as of 
the membrane of its cartilaginous rings, is, I am 
inclined to think, a general accompaniment of this 



ASTHMA. 149 

species of the disease ; and this is pointed out not 
less by the impediment presented to the action of 
swallowing than by the peculiar manner in which 
the breath is, as it were, sucked in. The posture, 
too, in which the patient ordinarily sits, with his 
head inclined forward, favours this belief: and 
would seem to show that the spasmodic contrac- 
tion of the connecting membrane of the rings of 
the trachea, in some degree, induced this position. 
That the lungs do not receive their due proportion 
of air, is conclusively proved by the want of 
natural clearness in the inspiration. 

Much variation exists in the auscultative signs, 
from the structural difference in the lungs occa- 
sioned by the habitual recurrence, or otherwise, of 
the disease. Thus, as Laennec has observed, the 
respiration is, in many instances, almost perfectly 
puerile ; although I do not conceive his explana- 
tion of this phenomenon to be satisfactory. I feel 
convinced, from repeated observations, that por- 
tions of pulmonary tissue are at times subject to 
spasm, and that to antagonize the contraction, the 
other portions assume an extraordinary power of 
expansibility. Repeatedly have 1 heard that part 
which at first yielded a clear sound become less 

13* 



150 ASTHMA. 

distinct, and the parts previously in a state of 
spasm, give out in their turn a puerile respiration. 
It has appeared to me that the portion influenced 
by spasm must by its contraction have the air 
contained within it forced out ; and whilst the 
other parts were receiving the air inspired, I have, 
unless my ear, well-accustomed to such minutiae, 
deceives me, heard the counter stream from the 
spasm, or spasms of the pulmonary tissue, escape. 
This phenomenon must not be confounded with 
that of interlobular emphysema of the lungs, 
noticed by Laennec, as being of rare occurrence, 
and the peculiar sound observable in which he 
denominates the friction of ascent and descent. 
The latter occurs but rarely in asthmatic patients ; 
whilst the former is met with early in the disease. 
The sound in this phenomenon, which I believe is 
now noticed for the first time, is less audible than 
the dry crepitous bubbling rattle which is the 
characteristic of interlobular emphysema. 

The character of the sound in asthmatic cases 
varies from a variety of circumstances. Thus the 
"rale sonore" the sonorous rattle, so far from 
presenting one uniform character, is divided into 
several sounds perfectly distinct from each other. 



ASTHMA. 151 

At times, it resembles the sighing of the wind 
through the trees ; at others, that of air violently- 
forced through a tube, as is the case with the 
bellows of a forge ; and in others again, it acquires 
a sharper sound, something betwixt a hiss and a 
whistle. The sound is occasionally broken into a 
kind of gurgling noise, like that made by a small 
brook; and, in some instances, like that produced 
by rubbing the finger over paper of a coarse 
texture, and uneven surface. This difference of 
sound depends, in great measure, on the state of 
the mucous membrane of the trachea ; and is also 
modified by the spasm or spasms of the bronchi, 
as well as their membranous terminations, and on 
the quickness with which the inspiration is made. 
Where the paroxysm has been very severe, and 
the patient exhibits much debility, as well as 
when the attack occurs late in life, a subcrepitous 
watery rale is sometimes heard, the diagnostic sign 
of oedema of the lungs. To hear the respiratory 
process in this, as well as in most other diseases, 
and more particularly to discern the sound made 
by the expulsion of air consequent on spasm, an 
eligible method is to place the ear over the apex 
of the lungs, or over the fine edges of this organ 
approaching the sternum. 



152 ASTHMA. 

Another peculiarity, attendant on this disease, 
will be perceived by auscultation; which is the 
irregularity and unevenness of the heart's action, 
occasioned by the effort it makes to overcome the 
opposing spasm of the respiratory apparatus. 
Percussion, in patients who suffer from permanent 
emphysema, produced by a long continuance of 
the disease, yields a sound clearer than natural ; 
but in recent cases, I have not observed this to 
happen. Much has been written concerning the 
immobility of the chest in asthma ; but this is only 
observable after a long series of attacks, and when 
the disorder has become habitual. From the over- 
exertion of the ribs, caused by excessive and re- 
peated anhelation, their cartilaginous extremities 
undergo ossification ; and I have known this to 
happen before the age of puberty, the patient 
having been affected from childhood. When the 
disease dates from an early age, this precocious 
change of structure from cartilage to bone prevents 
that enlargement of the chest, usually seen in asth- 
matics; but the chest partakes of the generally 
rounded form characteristic of the disease, and 
which arises in part from the antagonism offered 
by the muscles of inspiration to the contraction of 
the lungs. However, this tendency to ossify is 






ASTHMA. 153 

not so marked in the nervous, as in other species 
of asthma. 

This truly singular and terrible disease, " mor- 
bus maxime terribilis" as Willis terms it, is "not 
unfrequentiy hereditary; and this, with its fluctu- 
ating nature in some, and regular recurrence at 
stated periods in others, forms another marked 
feature in asthma. When we meet with cases in 
which the fits return invariably every month, as 
they often do at the catamenial period, or at the 
expiration of a certain number of months, or, as 
we have it on the authority of Heberden, after 
every seven years, the regularity of the occurrence 
coupled with similar phenomena in other disorders, 
would induce a belief that there were certain laws 
of nature, independent of the " seasons' difference" 
common "to mute and to material things," to which 
the health of man is periodically subservient. 

One extraordinary instance of this singular 
uniformity came under my knowledge in the 
person of a lady, a patient of mine, who, for 
eleven or twelve months, had alternate monthly 

attacks of epiiepsy, and of asthma, and this with 
the greatest regularity : a strong proof, I may 
observe, of the purely nervous character of the 
disease. 



154 ASTHMA. 

Bonnet relates, in his " Sepulchretum Ana- 
tomicum," that he had met with a case of asthma 
alternating with dysuria; and we find in the 
"Ephemerides des Curienx de Ja Nature," an 
account of an asthma which attacked the patient 
the moment he had composed himself to sleep. 

Among my own patients, I have lately had a 
singular example of the mind's forming the essen- 
tial circumstance of 'the disease. A female of the 
upper class of domestics, who was attacked with 
asthma, on her removing to the country, after 
having lived three years in London in the same 
situation, without any manifestation of her com- 
plaint, was seized, on her return, with a fresh 
paroxysm, just as she had obtained a new situa- 
tion. Every thing had been arranged to her 
satisfaction, and she was on the point of setting 
off, (it being abroad,) when the poor creature's 
hopes were destroyed by this untimely attack. 
Ever since, the same result attends her, when 
placed in the same circumstances ; and no sooner 
does she obtain a situation, and prepare to repair 
to it, than on the very day, and almost the very 
moment she is about to enter her new abode, her 
complaint incapacitates her from embracing the 
opportunity. 



ASTHMA. 155 

Among other cases recorded by Heberden, in 
addition to the one before alluded to, he states 
that he has known some patients to remain free 
from asthma (after having suffered under it 
several 3^ears) for the space of thirty years ; and 
he mentions that one person used to suffer from 
violent paroxysms for a single day, which would 
then cease, and after an indefinite period recur for 
the same brief space, endangering life from their 
excessive severity. 

I have quoted these instances from Heberden, 
as I probably shall do from others, rather with a 
view of showing that I have not neglected the 
writings of those whom, as a member of the 
College of Physicians, I am bound to reverence, 
than for any high opinion of their science. A 
note-book like Heberden's proves his attention 
to appearances, but throws no light on causes. 
However, like the cabinet of the virtuoso, the 
curiosities the possessor cannot explain, others 
may. I allude to the species of writing, not to 
Heberden. His fame was well-earned — for he 
wrote in Latin. 

The primary, or proximate cause of the purely 
spasmodic asthma is unknown; but from many 
reasons, that may be grounded on the facts I am 



156 ASTHMA. 

about to state, the inference will be that this 
species of the disorder positively depends on some 
alteration of the condition of the nervous in- 
fluence. The suddenness of the attack, the 
irritable temperament of the patient, the sympathy 
betwixt the mind and body peculiarly observable 
in this form, its periodic recurrence, its hereditary 
character, and, above all, the non-existence in the 
few instances in which it has been possible 
to make pathological observations, of any percepti- 
ble organic lesion, however minute, all tend to 
the same point. 

Nothing can be more various than the origin 
of this disease, as far as it can be traced. Almost 
every variety, however, is complicated with cold. 
Whether it depend chiefly on an affection of the 
trachea, or the numerous ramifications of the 
bronchi, or a peculiar state of the nerves, each or 
every of these influential and additional causes, is, 
for the most part, dependent on, or rather is com- 
plicated with cold. Hoffman observes, " Quern- 
admodum frigis, omnibus nervosis partibus 
infensum est : ita ?naxime pectori deprehendltur 
inimicissimum. Quamplures mihi cogniti sunt 
casus ubi ex eo solo liberalius admisso tusses, 
asthmata spasmodica, et cardialgix atrocissimas 



ASTHMA. 157 

propullarunt." Again, he says, " Si quid ex 
causis occasionalibus est quod asthma convulsi- 
um inducer e potest, certe est externum frigus, 
hostis ille nervoso generi inimicissimus." 

Without, however, recurring to authorities, a 
very little experience will prove that the more 
ordinary apparent cause is cold. To say posi- 
tively what is, or is not the cause, I cannot pre- 
tend to do.; and until we are acquainted with the 
proximate origin of epilepsy and hydrophobia, I 
firmly believe this " crux medicorum" will not 
be removed. Some injury done to the nerves of 
the chest, by cold or other means, would seem to 
be its most general exciting cause; but in this 
there is nothing positive. One of the best defined, 
and most exquisitely determined cases, that ever 
came under my knowledge, was in the person of 
a noble lady, wife of an officer of high rank, to 
whose immediate ancestor we are indebted for a 
large accession to our Indian territories. Convul- 
sive asthma first seized her after an attack of 
whooping cough, and I never witnessed the disease 
of a more purely convulsive, or a more distressing 
nature. In this lady there occurred a disturbed 
state of the mucous membrane of the trachea,with 
a decided catarrhal tendency, but the same symp- 

14 



] 58 ASTHMA. 

toms may be noticed in other individuals without 
the manifestation of any asthmatic disorder. 

Although the pneumo-gastric nerve sends out 
many filaments or branches to the lungs, in no 
other species of asthma does it appear so peculiarly 
excited as in the nervous. From various cases 
which have passed under my observation, this 
may, I think, be satisfactorily accounted for from 
some peculiar disposition of the nerves. 

A gentleman, a patient of mine, from making 
the common galvanic experiment with a piece of 
zinc and of copper in his mouth, was seized with 
tic douloureux, and became an intense sufferer 
from it. He would pass the edge of his nail along 
his upper lip several times, as a sort of test, or 
criterion, of his state ; when, if the liability to fits 
for the time being had ceased, no effect would 
ensue: but, if otherwise, no sooner was a certain 
minute point touched than he was thrown into the 
most acute agony. Coupling this with facts of a 
similar nature, such as lock-jaw from a trivial 
wound, we shall have the purely nervous nature 
of the disease rendered highly probable ; and it 
may, perhaps, be accounted for from an unusual 
distribution of the nervous filaments, as in the case 
of tic douloureux above-mentioned. I would refer 



ASTHMA. 159 

the obvious nervous influence to a sentient ex- 
tremity of the nerve's being seated somewhat 
nearer than usual to the cuticular surface. The 
laws of sympathetic association of muscular con- 
traction, will thus solve many phenomena of the 
disease. Although I certainly am inclined to think 
that some functional disorder, or morbid sympathy, 
of the nerves of the chest is the more immediate 
cause of true asthma ; yet reasoning from analogy, 
it is far from improbable that its origin may some- 
times be considerably removed from the seat of the 
disorder. Some years ago I was called to see a 
female who was suffering severely from tic dou- 
loureux. It was not until my second visit that I 
discovered she had lost a leg, which had been re- 
placed by one of cork. Inquiring into the history 
of her case, I found that in order to wear the arti- 
ficial one with the better regard to appearance, she 
compressed the stump of the amputated limb so 
forcibly, in inserting it into the false leg, as to con- 
strict the nerves in a very prejudicial manner. At 
least, conceiving this to be the case, 1 ordered her 
immediately to discontinue the use of it; and 
found, from the relief subsequently experienced by 
her, that my conjecture was right. 

Here was an evident proof of the intimate con- 



160 ASTHMA. 

nexion existing between the nervous extremities, 
or rather, as this required no additional proof, of 
the effect injury in one place might communicate 
to a more distant locality. 

I may here mention that having understood from 
the domestic physician of a gallant nobleman, re- 
presentative of his monarch in a sister kingdom, 
and who had lost a limb in the service of his coun- 
try, that he had become subject to attacks of the 
same distressing complaint, I related the above 
case to Dr. M., and had the satisfaction of intro- 
ducing him to my patient. Whether the hint was 
acted upon, I cannot say ; but from a communi- 
cation I received, with the thanks of his noble 
employer, I should trust that it had proved ser- 
viceable. 

A writer, who appears to have used much in- 
dustry in collecting materials for his work on 
Asthma, Dr. Bree, is of opinion that the spasm of 
the chest is an effort of nature to relieve the suf- 
ferer. Had he trusted to experience rather than 
the dogmas of others, and inclined to fact rather 
than theory, he would have seen reason to retract 
this doctrine. Some time ago I enquired of him 
if he had ever employed auscultation ; but he told 
me a defective state of hearing precluded him from 



ASTHMA. 161 

its use. Otherwise the ear would have convinced 
him, that he had embraced an erroneous view of 
the subject. But, independently of this, we find 
that in the humoural asthma, in which the effusion 
of serum is considerable, the spasms are trifling ; 
whilst in the nervous, at the commencement of 
which there is almost always a total absence of 
serous effusion, and its presence but slightly indi- 
cated at the end, that the spasmodic convulsion is 
of the most violent nature. 

Following the observations of Dr. Whytt, who 
truly remarks, that the contractions of the abdo- 
minal muscles, and diaphragm, in pregnancy, 
tenesmus, and stranguary, are marked with a wise 
intention, he quotes from the same writer, with 
great satisfaction, the following indisputable error, 
where he asserts that < the increased motion of the 
organs of respiration in the fit of an asthma are 
the efforts of nature to free the body of something 
hurtful.' 

By a parallel reasoning, it might be asserted 
that the lethal convulsion of the pharynx, conse- 
quent on a bite of the hand, for example, by a 
rabid animal, or the itching of the nose indicative 
of the presence of worms, were the efforts of 
nature to relieve the patient. 

14* 



162 ASTHMA 

Because instances of mercy and wisdom are 
visible in many apparent disturbances of the 
human frame, it is an abuse of reason to conclude, 
that no alteration in the animal economy can take 
place unless to effect a relative good. Palsy might, 
on such inferences, be deemed a blessing ; and the 
spasmodic rigidity accompanying tetanus the 
means of relief. A little reflection will show, that 
the inordinate muscular action in asthma is radi- 
cally injurious. It lays the foundation for an 
emphysematous state of lungs, which, although a 
blessing to an individual of a consumptive diathe- 
sis, is in other cases any thing but enviable. Thus 
frequent attacks of convulsive asthma generally 
end by rendering the disease chronic, and will even 
lead progressively, in some cases, from pulmonary 
or vesicular, to interlobular emphysema, and so 
induce the numerous train of ills which are com- 
plicated with asthma in its last and worst stage. 

It is perhaps necessary again to observe that 
nervous, or convulsive asthma, strictly so called, 
depends on some cause, or causes, hitherto un- 
known ; and that whenever the cause is definite, 
the disorder is a variety, and not a pure asthma. 
Thus in some individuals subject to attacks of 
gout, which have been suddenly arrested, or have 



ASTHMA. 163 

ceased for an indeterminate period, a difficulty of 
breathing has taken place, accompanied by spasm, 
which may, or may not arise from the non- 
appearance of the usual fit ; but in either case, it 
is the pure form of the disease, since we know not 
in what manner the suppression of the gout can 
influence the chest. Stimulation, or sympathy, is 
another exciting cause, as it likewise is in hysteria, 
and chorea ; and apprehension of an attack, the 
mere nervous dread of its recurrence, will not 
infrequently bring it on. The purely nervous 
nature of the disease is still further elucidated, by 
the paroxysms of asthma being often excited by 
powerful, and penetrating odours, such as those of 
ipecacuanha, the tuberose root, and other scents 
which are known to affect some individuals in a 
very violent manner. 

A medical gentleman of my acquaintance was 
subject to sudden attacks of asthma, but how 
produced he was long unable to ascertain. At 
length it occurred to him that he was invariably 
seized after sleeping in a particular bed, which 
had been presented to him by the captain of a 
ship in the Baltic trade. The feathers, from some 
process in drying, most probably emitted a pecu- 
liar smell, and to this he was led to ascribe the 



164 ASTHMA. 

origin of his atacks ; since on no other occasions 
did he ever suffer from them. 

Here is an exciting cause, to all appearance ; 
but the modus operandi of the odour on the 
nerves is so unknown to us, that we cannot ven- 
ture to term it a proximate one. 

Ferrus, in his ingenious article on Asthma, 
inserted in the " Dictionnaire de Medecine," has 
given a case of what he terms idiopathic, or 
essential asthma, which at the same time that it is 
instructive, is not a little characteristic of la grande 
nation. The patriotic feelings of the soldier, mad- 
dened at the sight of " foreign troops at the gates 
of the capital," furnish a Jittle touch of the senti- 
mental in the true Gallic vein. The case is as 
follows : — 

6 A young officer, full of talent and honour, 
grievously wounded in the last campaigns, but at 
the time in good health, returned in 1814, with 
his family to Paris, still occupied by the allied 
troops. He experienced so "great a shock on per- 
ceiving foreign soldiery at the gates of the capital, 
that he was immediately seized with a sense of 
uneasiness, and his respiration became difficult. 
This state became worse, and he had that very 
night a violent fit of asthma. The following 



ASTHMA. 165 

nights he was equally distressed ; and the inten 
sity of the symptoms did not decrease until fifteen 
days after the first attack. M. Corvisart was con- 
sulted ; and he perceived no certain index of 
organic lesion. The condition of the invalid was 
but little benefited by the most enlightened advice, 
or the most affectionate nursing. He repaired to 
the south of France for the winter, and entirely 
regained his health. 

'In 1815, the paroxysms of asthma recurred on 
his experiencing griefs, but with longer intervals, 
during which his health was good. He was 
seized, in 1820, with severe intermittent fever of 
an ordinate character. In the course of a journey 
which he took during his convalescence, he was 
again attacked by an asthmatic fit, after taking a 
warm bath, and subsequently stopping some hours 
in a place of public entertainment. The expecto- 
ration, which did not come on till the morning of 
the following day, consisted of sanguineous secre- 
tion, and in great quantity. No change in the 
state of the circulation was observable. The in- 
valid continued his journey, had a recurrence of 
the attack for four or five following nights, and 
recovered without even fc observing a strict regimen. 
During the last ten months, his health has been 



166 ASTHMA. 

good, he has devoted himself to numerous active 
exercises, and experiences no difficulty of breath- 
ing, except when mounting a stair-case too 
quickly.' 

I cannot conclude this part of my subject better, 
than by quoting the words of Delens. 

* Enfin, il faut le dire, dans quelques cas 
toutes les recherc/ies des anatomistes ont ite 
infructueuses, et V on n 9 a pu rapporter la ma- 
ladie qu' a une perversion de V influenee tier- 
veuse, dernier retranchement ou il faut bien 
nous rtfugiee en pareil cas pour ne pas etre 
oblige' d' admettre, comme nos predScesseurs, des 
maladies essentielles ? des maladies sans matiere, 
bien qu' a vrai dire, notre explication ne soitpas 
beauceup plus satisfaisunte que V espece d 9 ob- 
scurite dont Us cherchaient a couvrir leur igno- 
rance,'' " 

I would remark that the general treatment di- 
rected by most physicians for asthma is confined 
to the period of attack; this often gives much re- 
lief, but as remedies are not continued during the 
time of intermission, the disease returns at stated 
intervals with all its horrors. A disease so purely 
intermittent in its nature, can only be eradicated 
by a careful continuation of remedies during the 



ASTHMA. 167 

intermission, which shall tend to alter the state of 
the system to a degree, that must certainly prevent 
its recurrence. 

The chylipoietic viscera should be particularly 
attended to during the intermission, by the re- 
moval of crudities of the prima via, by regulating 
the diet, and the use of such medicines as may 
tend to keep up a healthy peristaltic action of the 
bowels, and the alterative pill of nitro muriate of 
gold. During the attack the treatment should be 
entirely directed to the nervous system; galvanism 
— a never-failing remedy in the treatment of pure 
neuralgia — should alone be relied on during the fit 
of asthma. 

This has always been my practice, and the 
success attending it prevents my seeking a better. 



RECAPITULATION. 

In the treatment of consumption, many reme- 
dies that are worse than useless, are still recom- 
mended by some physicians, such as the removal of 
tonsils, the use of blisters — sometimes perpetual,— 
emetics, cathartics, expectorants, demulcents, nar- 
cotics, alterative mercurials, astringents, tonics, 
balsams, inhaling iodine, sea voyages, southern 
climate, &c, &c. But as I have used all these, 
and witnessed their full trial in the hands of others, 
I conceive myself fully prepared to pass judgment, 
and declare them utterly inefficient. 

Exercise of the body and lungs, by inhalation, 
by gymnastics, or by the common pursuit of busi- 
ness, (where this is sufficient,) regulation in diet 
and digestion, attention to the healthy action of the 
skin, and all the secretions, by the daily use of re- 
medies I shall style prophylactics, will soon ac- 
complish what the patient may look for in vain 
from the use of medicines already tried and justly 
condemned 



170 RECAPITULATION. 

These prophylactic compounds will be constant- 
ly kept, by some of our most respectable druggists, 
accompanied with full directions. 

In conclusion I would remark that in the fore- 
going very brief sketch of the pathology and treat- 
ment of a disease hitherto considered as admitting 
of little more than palliative remedies, I aim at no 
literary fame. The harassing engagements of a 
laborious profession leave but little leisure or in- 
clination to cultivate the graces of composition. 
My object will be fully accomplished if by the 
labour, anxiety, and intense application of many 
of the best years of my life I have succeeded in dis- 
arming of its terrors one of the most formidable 
diseases to which flesh is heir; and of infusing into 
the hearts of despondent and weeping relations 
the cordial — hope. Justice must cede to me the 
merit of having contributed largely to effect this 
important and most desirable consummation; and I 
fully acquit myself of the charge of arrogance or 
presumption, when I assert my ability to control 
and cure a large majority of the cases of clearly 
developed pulmonary Consumption. 

finis. 



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